Referrals & Authorizations Specialist I

Millennium Physician Group•Land O' Lakes, FL

3d•Onsite

About The Position

This role involves collaborating with referring physician offices to ensure referrals are completed appropriately and in a timely manner. The specialist will review referral details and expectations with patients, communicate effectively regarding the EMR system, and possess basic knowledge of insurance information (HMO vs. PPO, classes of insurance) to instruct and explain to patients. Key responsibilities include making outgoing calls to patients about preferred in-network providers, verifying if patients need assistance coordinating appointments, confirming all information is attached to requests, and coordinating appointment scheduling with specialist offices on behalf of patients. The role also requires effective and professional communication with specialist offices, assisting in sending fax requests, and ensuring complete and accurate registration including patient demographics and insurance information. Additionally, the specialist will assemble information concerning a patient's clinical background and referral needs, providing appropriate clinical information to specialists per referral guidelines. The position demands effective communication, decision-making, and organization skills for efficient job performance, with daily work accomplished with minimal direct supervision and tasks prioritized effectively. Confidentiality of patient data and sensitive matters is paramount, and the role requires providing high-level customer service to both referring physicians and referred patients. Maintaining an organized and professional workspace and demonstrating a courteous and professional demeanor at all times are also essential.

Requirements

Bilingual Required: Spanish
Basic knowledge of insurance information (i.e. HMO vs. PPO), classes of insurance
Effective communication skills
Decision-making skills
Organization skills
Ability to work with minimal direct supervision
Ability to set work priorities to accomplish task/goals
Ability to handle confidential matters appropriately
Ability to maintain confidentiality of patient data at all times
Ability to maintain workspace in an organized and professional manner
Ability to demonstrate courteous and professional demeanor at all times

Nice To Haves

Experience with EMR system

Responsibilities

Collaborates with referring physician offices to ensure referrals are completed appropriately
Ensures that referrals are addressed in a timely manner
Reviews details and expectations about the referral with patients
Communicates effectively about the EMR system
Instructs and explains insurance information (i.e. HMO vs. PPO), classes of insurance to the patient
Makes outgoing calls to patients to inform them of the preferred in network provider that they are being referred to
Verifies if patient would like assistance in coordinating the appointment
Verifies with patient that all information is attached to request
Coordinates scheduling of appointments when appropriate on behalf of patients with specialist offices
Communicates effectively and professionally with specialist offices
Assists in sending Athena fax request to specialist office
Ensures complete and accurate registration, including patient demographic and current insurance information
Assembles information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist
Demonstrates the skills of effective communication, decision-making and organization to ensure efficient job performance and job success
Handles confidential matters appropriately
Provides high-level customer service to both referring physicians as well as referred patients
Maintains confidentiality of patient data at all times
Maintains workspace in an organized and professional manner
Demonstrates courteous and professional demeanor at all times