Referral Specialist

UCHealth•Fort Collins, CO

3d•Onsite

About The Position

The Referral Specialist ensures compliance with managed care, commercial insurance, and public insurance requirements by submitting and tracking referrals. The role supports efficient patient flow and service excellence and provides routine information to customers while monitoring patient needs and responding to inquiries. The position requires critical thinking, decisive judgment, and the ability to work with minimal supervision in a fast-paced environment and take appropriate action. It is an onsite, full-time role at the UCHealth Family Medical Clinic in Fort Collins, Colorado.

Requirements

High school diploma or GED.
Six months of experience in healthcare.
Critical thinking skills and decisive judgment.
Ability to work with minimal supervision in a fast-paced environment.

Nice To Haves

Associate's degree.

Responsibilities

Verify eligibility and benefits and obtain authorizations for treatment or precertification of high-cost drugs.
Track referrals to ensure compliance with guidelines.
Track formulary requirements.
Respond to questions from third-party payors, employers, internal staff, and physicians.
Maintain information on health plan guidelines and provide training on plan requirements.
Obtain an Advance Beneficiary Notice (ABN) or Notice of Exclusions from Medicare Benefits (NEMB) when required.
Ensure provider compliance with plan guidelines.
Protect the confidentiality of patient and institutional information.
Provide routine information to customers and relay information appropriately.
Monitor patient needs and respond to inquiries.
Prepare written reports.
Use critical thinking and decisive judgment, work with minimal supervision, and take appropriate action in a fast-paced environment.

Benefits

Three-Year Incentive Bonus.
Annual merit pay increase based on performance.
Annual market reviews and market-based pay adjustments.
Medical, dental, and vision coverage.
24/7 mental health and well-being support for employees and dependents.
Discounted gym memberships and fitness resources.
Free Care.com membership.
Voluntary benefits, including accident insurance, critical illness insurance, group legal plan, identity theft protection, pet insurance, auto and home insurance, and employee discount programs.
Paid time off (PTO), paid family and medical leave, and leaves of absence.
Employer-provided basic life and accidental death and dismemberment coverage, with buy-up options.
Employer-provided short-term and long-term disability coverage, with a buy-up option.
403(b) retirement plan with employer matching contribution.
A 457(b) plan may be available.
Flexible spending accounts for health care and dependent day care; a health savings account is available with enrollment in a high-deductible medical plan.
Tuition support for eligible educational programs, including up to 100% of tuition, books, and fees for specific degrees, and other qualifying programs up to $10,000 per year prepaid or $5,250 per year in tuition reimbursement.
Access to LinkedIn Learning and internal professional development opportunities.
Free assistance navigating the Public Service Loan Forgiveness program and submitting federal student loans for forgiveness.