Clinic - Referral Specialist - CMME Oth Anc Svcs Neurology

Prime Healthcare•Lewiston, ME

32d•Onsite

About The Position

Central Maine Healthcare (CMH) is seeking a Referral Specialist for its Central Maine Medical Center (CMMC) Oth Anc Svcs Neurology department. CMH is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine. CMMC is a 250-bed regional referral hospital with specialized centers for cancer care, orthopedics, and cardiology. CMH also includes Bridgton Hospital and Rumford Hospital, and is affiliated with the Maine College of Health Professions. The Referral Specialist will act as a liaison between insurance, healthcare providers, and the clinic to ensure referrals for medical specialty visits are processed correctly. This role involves scheduling referrals, communicating with clinics and patients, reviewing clinical data for medical necessity, and creating positive relationships with specialist offices. Other duties include filing, scanning patient reports, retrieving records for prior authorizations, and completing insurance prior authorizations. The ideal candidate will have knowledge of referral processes, medical terminology, insurance plans, and electronic medical systems, along with excellent customer service and communication skills.

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.
Scheduling 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.
Performs all work with accord to the mission, vision, and values of the practice.
Makes referrals to specialist for the office practices along with prior auth and creates positive relationships between the office practices and specialists.
Filing/scanning patient reports.
Retrieving patient records for prior authorizations or medical records.
Completes insurance prior authorization.
Demonstrates adequate knowledge of the usual terminology of Referral process and tests/surgeries along with insurance plans.
Demonstrates good telephone etiquette and be able to speak to patients and others in a polite and friendly manner.
Maneuvers through prior authorization with insurance companies.
Provide 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.