Referral Specialist Jobs

About The Position

Requirements

• High school diploma or equivalent.
• Computer and EMR experience.
• Organizational skills.
• Advanced typing skills.
• Ability to communicate well with people in personal contact and telephone conversations.
• Ability to effectively act as a liaison between patient and provider.
• Ability to follow oral and written instructions.
• Familiar with medical office practices and medical insurance.
• Familiar with ICD-10, CPT, HCPCS codes.
• Must be self-motivated and have the ability to work within the established policies, procedures, and practices prescribed by the hospital/clinic.

Nice To Haves

• Minimum two years’ general office work experience.
• Medical terminology.

Responsibilities

• Verify and obtain authorizations required by insurance companies for patient services.
• Complete registration and scheduling for the sleep center, including sleep studies and clinic visits.
• Communicate with the Care Team and funding sources.
• Manage time effectively and maintain organization.
• Demonstrate critical thinking, creativity, problem-solving, and decision-making skills.
• Maintain working knowledge of federal, state, local, and intermediary specific billing requirements to ensure appropriate authorizations are complete.
• Notify appropriate personnel of missing or incomplete billing requirements and follow up in a timely manner.
• Assist in educating the Care Team regarding authorizations and act as a resource.
• Ensure all pre-authorizations are approved with the proper procedure code prior to service.
• Stay knowledgeable of current changes in coding and reimbursement requirements for all billing payors.
• Contact providers with authorization, denial, and appeals process information.
• Research and resolve rejected, incorrectly paid, or denied claims in collaboration with patient success and billing departments.
• Greet patients and visitors courteously and friendly.
• Deal effectively with emotionally charged situations.
• Perform insurance verifications daily.
• Ensure all necessary documentation is completed prior to obtaining authorization.
• Ensure all documentation required for authorization is obtained and forwarded to the proper entity.
• Close the referral loop by ensuring all necessary documentation has been received.
• Schedule patients for sleep studies once authorization is obtained.
• Work from the referral pool to schedule visits in the clinic.
• Register all sleep center patients.
• Maintain regular and predictable attendance.
• Perform other essential duties as assigned.