Referral Specialist

Primary Responsibilities

• Works full time, on site, to support the operations of the department and AMA-PC
• Maintain a high level of professionalism and provide excellent patient servicing
• Schedule future appointments following the individual provider's protocol
• Verify eligibility on all Mass Health members before scheduling the appointment
• Follow phone queue daily assignment
• Retrieve night and referral voicemail when assigned and follow-up on the messages
• With the managers assistance, learns to problem solve and assist with the more complex referral requests
• Follow-up with specialist offices to obtain pertinent information that is essential for the referral processing workflow
• Enters referral requests in the Allscripts EMR from patient calls, Follow My Health or faxes received from physician offices
• Absorb PCP approvals for insurances that require a physician signature and reviewer's 2nd signature
• Confirm specialist participation with insurance via the individual health plans website
• Process referrals utilizing the correct web sites, and follow the 4-5 business day referral processing protocol
• Must observe HIPAA & PHI (Protected Health Information) Regulations at all times
• Other duties as assigned by Call Center Manager or Director

Required Qualifications

• High School graduate or GED equivalent
• Current Massachusetts nursing license
• BCLS Knowledge of EMR, scheduling and word processing software
• Friendly and courteous personality
• Excellent communication skills and the ability to maintain confidentiality

Pay and Benefits

• Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
• In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• The hourly pay for this role will range from $16.00 to $29.00 per hour based on full-time employment.
• We comply with all minimum wage laws as applicable.

About the Role

Join a team at the forefront of value-based care and discover the meaning behind Caring. Connecting. Growing together.

Skills

• Excellent communication skills
• Computer and phone skills
• Multi-tasking ability

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (subject to eligibility requirements)

Benefits

• Drug-free workplace policy
• Equal employment opportunity employer
• Commitment to mitigating impact on the environment
• Enterprise priority to address health disparities and improve health outcomes