Referral Specialist

Duties

• Schedules appointments for specialty physician services and diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements
• Acts as a liaison between patients, providers and staff members for patients’ referral and follow up needs
• Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed
• Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities
• Tracks and manages all referrals by monitoring outstanding referrals at 30/60/90 day intervals and following up with patients if appointments are not kept
• Applies knowledge of medical terminology and maintains up to date knowledge of insurance environment
• Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources
• Maintains an updated list of community resources and networks with colleagues to develop additional referral sources

Core Functions

• Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards
• Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day

Minimum Qualifications

• High school diploma/GED or equivalent working knowledge
• Possesses 1 year of direct patient interaction/experience in a medical, insurance, or healthcare related industry
• Knowledge of HIPAA regulations
• Strong customer service focus and willingness to problem solve
• Effective verbal and written communication skills and the ability to manage competing priorities
• Must be proficient with commonly used office software

Preferred Qualifications

• Previous knowledge of managed care concepts
• Working knowledge of medical terminology and ICD-9 and CPT codes