Referral Specialist, Pulmonology, FT, Days

Prisma Health•Columbia, SC

5d•Onsite

About The Position

Provides patients with a seamless entry into the Prisma Health experience by coordinating referrals and communicating with patients, physician-office teams, specialist offices, and third-party payors. The role handles authorizations and precertifications, transmits clinical documentation through electronic medical records, and tracks referral progress through consultation, procedure, or test completion. It also helps patients address scheduling, financial, and social barriers while maintaining confidentiality and supporting an effective patient and team-member experience.

Requirements

Two years of related work experience.
Customer service, communication, and interpersonal skills.
Knowledge of health insurance companies.
Knowledge of medical terminology, CPT and diagnosis coding, insurance verification and updates, and authorization/precertification processes.
Knowledge of Microsoft Office products.
Maintain patient confidentiality and comply with HIPAA and compliance guidelines.

Nice To Haves

High school diploma or equivalent preferred.
Experience in a physician front office, including patient registration and/or electronic scheduling and authorization/precertification processes, preferred.
Equivalent work experience and/or education may be considered in lieu of the stated education or experience, such as an associate degree or higher.

Responsibilities

Coordinate authorizations and precertifications with internal and outside organizations and insurance companies to meet prior-approval requirements.
Present necessary medical information, including history, diagnosis, and prognosis, and provide relevant information to financial services to support reimbursement.
Record demographic, coverage, and scheduling information in applicable systems.
Remind patients of scheduled appointments by mail, internet, or telephone, using each patient’s preferred contact method.
Keep the patient’s primary care chart up to date with scheduling information for specialist consultations, tests, and procedures.
Alert management to trends in appointment availability and appointment timeliness.
Support meaningful use of the electronic medical record on behalf of referring physicians.
Document referral status, scheduled appointments, and referral-related actions and encounters in the appropriate tracking system.
Follow up after consultations, procedures, and tests to confirm that the physician received the report, and continue checking until complete.
Serve as a liaison among providers, practices, patients, and specialists; provide specialist offices with appropriate clinical information and referral needs.
Verify physician orders and communicate guidelines, protocols, and locations to patients.
Help patients address healthcare-navigation issues, financial obligations, and social barriers, including arranging interpreters, transportation services, or prescription assistance when appropriate.
When appropriate, advocate with insurance carriers to secure timely approval for necessary patient services or supplies.
Address patients’ scheduling requirements, questions, and concerns; book timely appointments and explain referral-process details and expectations.
Maintain patient confidentiality and comply with HIPAA and Prisma Health compliance guidelines.
Support effective and efficient facility operations and a positive patient, physician, and team-member experience.
Perform other duties as assigned.