Referral Specialist - Neurosurgical Care

EvergreenHealth • Kirkland, WA

7d

About The Position

The Referral Specialist coordinates and handles the administrative requirements for patient referrals from primary care providers to specialists or specialty services, working directly with health plans. The role makes decisions and authorizes risk-planning referrals in accordance with department and organizational guidelines. It requires daily interaction with patients, staff, healthcare providers, and insurance companies.

The specialist demonstrates mastery of Patient Service Representative duties, processes and troubleshoots referrals, coordinates managed-care referral information, and assigns appropriate ICD-10 and CPT codes. The role also communicates contractual and system-process information and shares changes in insurance requirements, providers, and guidelines with leaders and team members. Other duties may be assigned.

Requirements

• Associate degree or equivalent combination of education and experience.
• Three years of experience in a healthcare insurance or related medical office setting.
• Working knowledge of ICD-10 and CPT codes.
• Ability to be flexible and relate well with others in a professional and pleasant manner.
• Knowledge of medical-records confidentiality.
• Excellent communication skills, with a high degree of tact and poise when dealing with patients, physicians, and hospital staff members.

Nice To Haves

• Medical terminology, medical billing, and computer skills.
• Working knowledge of insurance, Medicare, DSHS, Labor and Industries, and other third-party insurance.

Responsibilities

• Demonstrate mastery of all Patient Service Representative duties.
• Process patient referrals from primary care providers to specialists, working directly with health plans and troubleshooting when necessary.
• Coordinate information regarding managed-care referrals for patients, providers, case managers, and other Utilization Management staff.
• Assign proper ICD-10 and CPT codes to patient referrals.
• Communicate and disseminate key managed-care contractual information and system processes to patients and staff.
• Identify and communicate changes in insurance requirements, provider changes, and guidelines to leaders and team members.
• Perform other duties as assigned.

Benefits

• Medical, vision, and dental insurance.
• On-demand virtual health care.
• Health Savings Account.
• Flexible Spending Account.
• Life and disability insurance.
• Retirement plans (457(b) and 401(a) with employer contribution).
• Tuition assistance for undergraduate and graduate degrees.
• Federal Public Service Loan Forgiveness program.
• Paid Time Off/Vacation.
• Extended Illness Bank/Sick Leave.
• Paid holidays.
• Voluntary hospital indemnity insurance.
• Voluntary identity theft protection.
• Voluntary legal insurance.
• Pay in lieu of benefits premium program.
• Free parking.
• Commuter benefits.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree