Referral Representative

About the role

Working under the direction of the Referrals Supervisor, this position is responsible providing a variety of support services which are essential to the efficient operation of the organization’s referral process. Works closely with the clinical department staff as well customer service staff in the offices.

Responsibilities

• Process and maintain the electronic Epic Referrals Workqueue prescreening for completeness of information, urgency, and other designated criteria
• Completes pre-authorization workflows as required
• Contact insurance companies to ensure prior approval requirements are met
• Reviews and updates patient registration for membership eligibility and PCP selection
• Enters referrals into the system per Trinity Health Of NE MGPS per protocols and provides feedback to ordering provider as needed
• Informs maintenance analyst/resource library of payor, benefit specific information and provider contact information updates accordingly
• Answers incoming phone calls as required to assist all internal and external customers by offering guidance and support for referral related questions, process and problems
• Other duties as assigned by Manager and Supervisor

Requirements

• High school diploma or equivalent
• Minimum of three (3) years’ experience in healthcare preferred