Referral Specialist

At Duly Health and Care/Quincy Medical Group/The South Bend Clinic, you are supported to do your best work and make a meaningful impact every day. You will be part of a collaborative, physician-led team that works as one and puts patients at the center of everything we do. With a connected network of providers, care teams, and services across primary and specialty care, surgery centers, imaging, lab, and therapy, you are part of a system designed to deliver high-quality, coordinated care. Together, we create an environment where you can grow, contribute, and help improve the experience and outcomes for every patient we serve. Benefits Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance. Access to a mental health benefit at no cost. Employer provided life and disability insurance. $5,250 Tuition Reimbursement per year. Immediate 401(k) match. 40 hours paid volunteer time off. A culture committed to community engagement and social impact. Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met. Referral Specialist Oncology Full Time Clinic Hours: Monday through Friday 8am-5pm Major Responsibilities Manages daily appointments for assigned locations, including all necessary tasks associated with processing, tracking and ensuring authorization of all infusion visits before scheduling including: Documents and processes referral requests from providers through the EPIC system, and edits referral notes with appropriate information as outlined per department procedures. Utilizes payor portals to verify patient eligibility, and contact patients regarding insurance coverage, appointments needing rescheduled, payor authorization issues, and other information that needs to be communicated. Maintains a current working knowledge of all Health Plan carrier requirements for referral request authorizations and approval path requirements. (Pre-Determinations and Peer to Peers, completion of insurance forms) Per referral guidelines, evaluates each referral request to ensure it includes current codes, place of service, service type, provider, and all required medical information is available for submission to insurance carriers. Applies knowledge and application of ICD-10 and CPT coding, as well as medical terminology for appropriate communication with physicians and providers. Investigates and works with physician/provider offices regarding missing information, steerage, answering questions, and provides ongoing education regarding referral process and requirements. Works collaboratively with Duly third party vendors to assist in identifying Oncology-specific information needed from payers. Communicates regularly with assigned locations on updates and/or changes to patient visit authorizations. Responds to and completes requests in work queues, Epic pools, Epic in-baskets, staff messages, Epic chats, and email according to prescribed standards and timeframes. Provides source of referral and prior approval requests with timely notification of approval or denial decisions through designated communication routes. Ensures authorization is completed for all Oncology and non-Oncology infusions prior to patient appointments being scheduled/DAR Scrubbing. Alert appropriate parties if authorization is pending. Adds external provider orders into Epic. Provides input to Manager regarding improvements to operating practices. Keeps up to date with referral process changes. Ensures turn-a-round times for referral Epic work queues meets prescribed standards. Covers and fills in for other locations/individuals when other Infusion Referral Coordinators are out of the office. Assists with orientation and training of new staff. Other duties as assigned related to this position. Qualifications Working knowledge of Epic system preferred Experience in ARIA or other Record and Verify platforms preferredExperience working with physicians and clinical staffTwo years of experience in a patient/client-facing role and/or familiarity with insurance/ authorizations preferredUnderstanding of medical terminologyProficient computer navigation skills, with basic/advanced Microsoft Office/Outlook and intra/internet experienceWorking knowledge of Epic system preferredExperience with phone and work queuesKnowledge of OSHA, HIPAA, and employment legislationHigh School Diploma or GED required; College Education preferred The compensation for this role includes a pay range of $16.35-24.52, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package. Artificial Intelligence Disclosure Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.