Referral Representative (temp)

Description Of Primary Responsibilities

• Assists patients with the completion of referrals including multiple service lines.
• Captures and organizes workload based on acuity.
• Coordinates and communicates with various insurance carriers to obtain necessary pre-authorizations for patients to receive needed specialty services.
• Verifies patient eligibility to determine the best options for specialty access.
• Schedules patient appointments with external and internal specialists and provides communication to the patients regarding the process and referral status.
• Ensures proper use of CPT and current ICD-10 codes to meet the requirements of third-party payers and specialty offices to ensure minimal delay in securing referral appointments or pre-authorizations.
• Prepares comprehensive referral packet, including referral order, pre-authorization paperwork, patient demographics, eligibility verification, primary care provider notes, diagnostics and/or lab work pertinent to the specialty referral.
• Sends required referral packet and documentation to the specialist to ensure timely processing of the referral.
• Ensures the efficient and timely processing of open referrals, including facilitating missing information, and that all referrals are appropriately closed and communicated to provider team.
• Addresses incoming calls and questions from patients and specialists regarding referral orders, care coordination, and ensures the appropriate follow-up is completed.
• Coordinates surgeries with designated hospitals, specialists, and patients. Obtains hospital pre-admission from the various health insurances and health plans.
• Submits referral activity reports to supervisor.
• Utilizes the electronic health record system to obtain and document necessary information.
• Maintains accurate records of referral processing activity, including interactions with patients, providers, and specialists.
• Uses third party payer/insurance portals appropriately to ensure adequate processing of referral orders.
• Follows-up on completion of the entire referral process, including closing referrals.
• Provides orientation on the referral process to new providers and periodic in-services to existing providers and staff regarding referral process.
• Achieves specific referral productivity metrics.

Description Of Primary Attributes

• Professional & Technical Knowledge: Possesses work-related skills at a higher level than completion of high school, including formal written and verbal communications skills, computational and computer skills, mathematical, and technical skills.
• Technical Skills: Ability to prepare more complex documents in Microsoft Word, including creating tables, charts, graphs and other elements; Ability to use Microsoft Excel to review and compile data, including the use of formulas, functions, lookup tables and other standard spreadsheet elements; Ability to create basic presentations in Microsoft PowerPoint.
• Licenses & Certifications: Medical Assistant certification preferred.
• Communications Skills: Job duties require the compilation of information prepared in effective written form, including correspondence, reports, articles or other documentation. Effectively conveys technical information to non-technical audiences.

Physical Demands

• The physical demands described here in this job description are representative of those that must be met by an employee to successfully perform the essential functions of this position.
• While performing the duties of this position, the employee is regularly required to sit and use repetitive hand movement to type and grasp.
• The employee is frequently required to stand or walk; and occasionally lift and/or move up to 20 pounds.

Pay Scale

Min Hourly Rate: $21.00
Max Hourly Rate: $28.60