Referral Specialist - Internal Medicine

Prime Healthcare•Lewiston, ME

7d•Onsite

About The Position

The Referral Specialist in Internal Medicine acts as a liaison between insurance, healthcare providers, and the clinic to ensure required referrals for medical specialty visits are processed correctly. This role involves scheduling referrals for patients at the request of providers and/or staff, directly communicating with clinics, referred-to clinics, and patients. The specialist reviews clinical data to report medical necessity to insurance companies and makes referrals for office practices, handling prior authorizations and fostering positive relationships between offices and specialists. Other duties include filing/scanning patient reports, retrieving patient records for prior authorizations or medical records, and completing insurance prior authorizations. The role requires knowledge of referral processes, medical terminology, tests/surgeries, and insurance plans, along with good telephone etiquette and customer service skills. The Referral Specialist assists patients by utilizing resources like sliding fee scales and payment arrangements, conveying a positive image of the organization with a friendly attitude.

Requirements

Knowledge of Electronic Medical Systems.
Excellent phone skills and customer service skills.
Upbeat, positive, customer friendly attitude towards internal and external customers.
Knowledge of prior authorizations and insurance plans.
Good organization skills.
Be able to act as a patient liaison to help them through navigate the healthcare system.
Be a self-starter and able to multi-task.
Able to organize and trouble shoot scheduling and or referral issues and have solutions.
Detailed orientated.
Be able to work in a changing environment.

Nice To Haves

2 year experience in a clinic work environment preferred.
Knowledge of medical terminology preferred.
Completion of medical assistant program desired Certified within 6 months of hire.

Responsibilities

Acts as a liaison between insurance, healthcare providers, and the clinic to ensure required referrals have been processed correctly for medical specialty visits.
Schedules referrals for patients at the request of providers and/or staff.
Directly communicates with the clinics, referred to clinics, and patients.
Reviews clinical data to report medical necessity to insurance companies.
Makes referrals to specialists for the office practices along with prior authorization.
Creates positive relationships between the office practices and specialists.
Files/scans patient reports.
Retrieves patient records for prior authorizations or medical records.
Completes insurance prior authorization.
Provides patient support by utilizing resources such as sliding fee scale, payment arrangements etc.
Conveys a positive image of the organization and maintains a upbeat customer friendly attitude for internal and external Customers.