Referral Specialist-Full time

Trinity Health • Central City, IA

1d

About The Position

The Referral Specialist manages and facilitates patient referrals, authorizations, and scheduling appointments, tests, and procedures at designated locations. Serving as a liaison between patients, providers, and medical support staff, the referral specialist ensures timely coordination of care by verifying insurance eligibility, obtaining prior authorizations, and entering necessary demographic and insurance information into clinic and hospital systems. The role also includes handling phone communications, supporting referral management operations, and adhering to the mission, vision, and performance expectations of MercyOne Medical Group. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Works directly with patients, families, insurance representatives, physicians, and vendors to facilitate the referral process. Coordinates, processes, and tracks patient referrals, authorizations, and scheduling with accuracy and attention to detail. Verifies insurance coverage, obtains prior authorizations, and communicates approval/denial to patients. Schedules patient appointments with appropriate specialists and providers, ensuring timely communication of appointment details. Maintains accurate documentation of referrals, prior authorizations, communications, and patient scheduling in the EMR system. Assists patients with insurance verification, prior authorizations, and required documentation for medical services and tests. Communicates and follows up with insurance companies, providers, and patients regarding referral status, appointments, and test results. Must be comfortable operating in a collaborative, shared leadership environment. Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.

Requirements

• High school diploma or equivalent required.
• Minimum of 1 year of relevant experience in a healthcare setting required, with prior medical office experience preferred.
• Ability to maintain confidentiality and adhere to HIPAA regulations.
• Must be able to communicate effectively, both verbally and in writing, and demonstrate proper telephone etiquette.

Nice To Haves

• Knowledge of ICD, CPT coding, medical terminology, and healthcare billing/authorization processes is preferred.

Responsibilities

• Works directly with patients, families, insurance representatives, physicians, and vendors to facilitate the referral process.
• Coordinates, processes, and tracks patient referrals, authorizations, and scheduling with accuracy and attention to detail.
• Verifies insurance coverage, obtains prior authorizations, and communicates approval/denial to patients.
• Schedules patient appointments with appropriate specialists and providers, ensuring timely communication of appointment details.
• Maintains accurate documentation of referrals, prior authorizations, communications, and patient scheduling in the EMR system.
• Assists patients with insurance verification, prior authorizations, and required documentation for medical services and tests.
• Communicates and follows up with insurance companies, providers, and patients regarding referral status, appointments, and test results.
• Must be comfortable operating in a collaborative, shared leadership environment.

What This Job Offers

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