Referral Specialist

Prime Healthcare•Joliet, IL

5d•Onsite

About The Position

The Referral Specialist acts as a liaison between insurance companies, healthcare providers, and the clinic to ensure referrals for medical specialty visits are processed correctly. The role schedules referrals at the request of providers or staff and communicates directly with clinics, referred-to clinics, and patients. It reviews clinical data to report medical necessity to insurers, completes insurance prior authorizations, and makes specialist referrals for the office practices while building positive relationships with specialists. Additional duties include filing and scanning patient reports, retrieving patient records for prior authorizations or medical records, helping patients navigate the healthcare system, and providing support through resources such as sliding fee scales and payment arrangements. The specialist should understand referral terminology, tests and surgeries, and insurance plans; demonstrate courteous telephone and customer-service skills; and maintain a positive, customer-friendly image when working with internal and external customers. The role is full-time, Monday through Friday, on a day shift at the Prime Healthcare Medical Group facility at 301 N Madison St, Joliet, Illinois.

Requirements

Knowledge of electronic medical systems.
Excellent telephone and customer-service skills.
Knowledge of prior authorizations and insurance plans.
Good organizational skills and attention to detail.
Ability to act as a patient liaison and help patients navigate the healthcare system.
Ability to self-start and multitask.
Ability to organize and troubleshoot scheduling or referral issues and identify solutions.
Ability to work in a changing environment.
Upbeat, positive, customer-friendly attitude toward internal and external customers.

Nice To Haves

Two years of experience in a clinic work environment preferred.
Knowledge of medical terminology preferred.
Completion of a medical assistant program desired; certification within six months of hire.

Responsibilities

Coordinate referrals between insurance companies, healthcare providers, and the clinic to ensure required referrals for specialty visits are processed correctly.
Schedule referrals for patients at the request of providers or staff.
Communicate with clinics, referred-to clinics, and patients.
Review clinical data and report medical necessity to insurance companies.
Make specialist referrals for office practices and complete prior authorizations.
Build positive relationships between office practices and specialists.
File and scan patient reports and retrieve patient records for prior authorizations or medical records.
Help patients navigate the healthcare system and provide support using resources such as sliding fee scales and payment arrangements.
Maintain a positive, customer-friendly attitude and convey a positive image of the organization.
Perform work in accordance with the practice's mission, vision, and values.