Ambulatory Referral Specialist
This is a hybrid/remote position. You must live in Tucson or the surrounding areas.
About the role
This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a multispecialty practice. The Referral Specialist provides all pertinent clinical information needed for payor authorization and the facility or specialist prior to services being rendered. Acting as a liaison between the patient and the specialty area, this role navigates the appointment process and ensures proper authorizations are obtained to provide a seamless experience for patients. The position tracks and manages all referrals to close patient care gaps and provides documentation to promote team awareness.
Banner University Medical Group is a nonprofit faculty practice plan associated with the University of Arizona Colleges of Medicine in Phoenix and Tucson. Our 1,100-plus clinicians provide primary and specialty care to patients at highly ranked Banner–University Medical Centers and dozens of clinics while mentoring more than 1,200 residents and fellows. Our practice values and encourages the three-part mission of academic medicine: research, education, and excellent patient care.
Responsibilities
- Schedules and/or coordinates appointments for incoming referrals to assigned specialty physician services and/or diagnostic testing per provider request, and communicates with the patient on a timely basis for all scheduling requirements.
- Schedules and/or coordinates scheduling and authorizations for provider pre-planned in-office procedures ordered by assigned specialty(ies).
- Acts as a liaison between patients, providers, departments, and staff members for patients’ referral and follow-up needs.
- Provides prompt and professional service by assisting in educating patients/families and connecting them with external resources when needed.
- Collaborates with providers and departments to determine all CPT codes needed for authorization before appointments.
- Provides all pertinent clinical information for payor authorization, verifies coverage, obtains authorization, and communicates with receiving facilities for incoming referrals and pre-planned in-office procedures.
- Reviews upcoming provider schedules to ensure all appointments have appropriate referrals and authorizations required for anticipated visits and procedures.
- Applies knowledge of medical terminology, ICD-10, and CPT codes, and maintains up-to-date knowledge of the insurance environment.
- Utilizes internal and external resources to stay informed about regulations regarding various payor sources.
- Collaborates with outside referral sources and other community resources, maintaining an updated list of community resources and networking with colleagues.
This position requires frequent communication with patients, physicians, staff, departments, and third-party payers. The role involves working with and understanding managed health care concepts, prioritizing tasks within established guidelines, and working with minimal supervision.
Requirements
- High school diploma/GED or equivalent working knowledge.
- Knowledge of medical terminology, ICD-10, CPT codes, and a broad understanding of common insurance and payor types and authorization requirements, typically acquired through two or more years of work experience in the healthcare field.
- Proficiency in common office software, word processing, spreadsheets, and EMR software.
- Ability to manage multiple tasks simultaneously with minimal supervision and work independently.
- Strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences.
- Knowledge of HIPAA regulations.
- Strong customer service focus and willingness to problem-solve.
Preferred Qualifications
- Previous knowledge of managed care concepts.
- Working knowledge of medical terminology, ICD-10, and CPT codes.
- Additional related education and/or experience.
Schedule
Monday – Friday, 8:30 AM – 5:00 PM