Referral Specialist - Endocrinology/Rheumatology

Prime Healthcare•Lewiston, ME

4d•Onsite

About The Position

The Referral Specialist acts as a liaison between insurance, healthcare providers, and the clinic to ensure required referrals have been processed correctly for medical specialty visits. This role is responsible for scheduling referrals for patients at the request of providers and/or staff, directly communicating with clinics, referred-to clinics, and patients. The specialist reviews clinical data to report medical necessity to insurance companies and makes referrals for office practices, handling prior authorizations and fostering positive relationships between offices and specialists. The position requires knowledge of referral processes, medical terminology, and insurance plans, along with excellent customer service and organizational skills. The Referral Specialist also provides patient support by utilizing resources like sliding fee scales and payment arrangements, conveying a positive image of the organization with a friendly attitude.

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 is able to speak to patients and others in a polite and friendly manner.
Maneuvers through prior authorization with insurance companies.
Provides 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.