Referral Specialist

Responsibilities

• Handle incoming clinical tasks, phone calls, and in-person requests, reviewing clinical history and obtaining notes for provider when needed; ensuring correct payer, CPT, and ICD-10 codes are on referral requisition.
• All referrals are processed in a timely and efficient manner and according to the referral policies and procedures; insurance benefit and eligibility is confirmed prior to processing the referral, ensuring patient is assigned to a SH provider.
• Arrange appointments with external and internal specialties, faxing referral requisition and any pertinent information.
• Patients, or parent/legal guardian, are notified verbally regarding their appointment date, time, location, special instructions, and out-of-pocket expenses if applicable.
• Follow up on referrals pending prior authorization/appointment is done at least weekly, documenting all efforts made in EHR.
• Use of good time-management skills; contributing to increased productivity.
• Actively participating in staff meetings and working toward accomplishing department goals and objectives; ability to work well with team members. Accomplishing related results as needed.
• Statistics of all referrals processed are reported weekly to the Practice Manager.
• Uses multiple software systems for insurance verifications and referral processing purposes.
• Demonstrates an understanding of organizational structure by utilizing appropriate channels of communication regarding all facets of departmental activities.
• Uses computers, fax/copy machines for the exclusive uses of clinic business; keeping work areas clean and organized at all times.
• Adheres to HIPAA confidential practices for patient information.
• Adhering to all Sunset Health policies and procedures.
• Performs other duties as assigned.

Qualifications

• High school diploma or equivalent.
• One year of experience in a healthcare setting preferred.
• Strong computer skills, including proficiency with Microsoft Office applications.
• Excellent verbal and written communication skills.
• Ability to manage multiple tasks and prioritize effectively.
• Knowledge of ICD-10 coding and CPT codes.
• Experience with electronic health records (EHR).