Referral Specialist

Sunset Health•Yuma, AZ

10h•Onsite

About The Position

The Referral Specialist is responsible for handling incoming clinical tasks, phone calls, and in-person requests. This includes reviewing clinical history, obtaining necessary notes for providers, and ensuring the accuracy of payer, CPT, and ICD-10 codes on referral requisitions. All referrals must be processed efficiently and in accordance with established policies and procedures. Confirmation of insurance benefits and eligibility is required before processing referrals, and patients must be assigned to a SH provider. The role also involves arranging appointments with external and internal specialists, faxing referral requisitions and relevant information, and verbally notifying patients (or their guardians) about appointment details, including date, time, location, special instructions, and any applicable out-of-pocket expenses. Follow-up on referrals pending prior authorization or appointment is expected at least weekly, with all efforts documented in the EHR. The position requires good time-management skills to enhance productivity, active participation in staff meetings, and collaboration with team members to achieve departmental goals. Statistics on processed referrals are reported weekly to the Practice Manager. The specialist will utilize multiple software systems for insurance verifications and referral processing, demonstrate an understanding of organizational communication channels, and use clinic business equipment appropriately. Maintaining a clean and organized work area and adhering to HIPAA confidential practices and all Sunset Health policies and procedures are also key responsibilities. Other duties as assigned.

Requirements

Experience with multiple software systems for insurance verifications and referral processing.
Understanding of organizational structure and appropriate communication channels.
Ability to keep work areas clean and organized.
Adherence to HIPAA confidential practices.
Adherence to all Sunset Health policies and procedures.

Nice To Haves

Good time-management skills.
Ability to work well with team members.

Responsibilities

Handle incoming clinical tasks, phone calls, and in-person requests.
Review clinical history and obtain notes for provider when needed.
Ensure correct payer, CPT, and ICD-10 codes are on referral requisition.
Process all referrals in a timely and efficient manner according to referral policies and procedures.
Confirm insurance benefit and eligibility prior to processing the referral.
Ensure patient is assigned to a SH provider.
Arrange appointments with external and internal specialties.
Fax referral requisition and any pertinent information.
Notify patients, or parent/legal guardian, verbally regarding their appointment date, time, location, special instructions, and out-of-pocket expenses if applicable.
Follow up on referrals pending prior authorization/appointment at least weekly, documenting all efforts made in EHR.
Use good time-management skills to contribute to increased productivity.
Actively participate in staff meetings and work toward accomplishing department goals and objectives.
Work well with team members and accomplish related results as needed.
Report statistics of all referrals processed weekly to the Practice Manager.
Use multiple software systems for insurance verifications and referral processing purposes.
Demonstrate an understanding of organizational structure by utilization of appropriate channels of communication.
Use computers, fax/copy machines for clinic business.
Keep work areas clean and organized at all times.
Adhere to HIPAA confidential practices for patient information.
Adhere to all Sunset Health policies and procedures.
Perform other duties as assigned.