Referral Specialist

CommonSpirit Health • Chattanooga, TN

2d • Onsite

About The Position

CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.

As our Referral Specialist, you will orchestrate patient access to specialized care by expertly managing all referral and authorization processes. Every day, you will proactively obtain clearances for specialty visits, issue referrals for ancillary services (consults, imaging, labs), and secure approvals for medications, DME, home health, and other vital services. To be successful in this role, you will demonstrate meticulous attention to detail, strong organizational skills, and clear communication to ensure seamless and efficient service delivery for our patients.

Requirements

• High School Graduate General Studies or High School GED
• 2 years of progressively responsible related experience in a healthcare environment, upon hire

Nice To Haves

• 2 years of progressively responsible related experience in a healthcare office environment specializing in the referral process
• Experience in AEHR and PPMS system

Responsibilities

• Gather, verify, and process orders for test, referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
• Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.
• Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
• Communicates or gives written material to patients with referral information such as date, time, and location, as well as contact information to ensure patient has resources to review if needed.
• Coordinate flow of information between medical clinic and patients insurance for referral authorization to secure a valid referral for clinic patient.
• Enter and annotate testing information and referrals, does e-referral for applicable practices for meaningful use and follows-up to make sure e-referral and or faxed referrals are received, documents communications and action into PPMS and AEHR, as appropriate.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED