Referral Specialist

Description

Summary

Ensures compliance with managed care, commercial insurance, and public insurance requirements. Submits and tracks referrals. Provides efficient patient flow and service excellence.

Responsibilities

• Verifies eligibility and benefits; obtains authorizations for treatment or precertification of high cost drugs.
• Tracks referrals to ensure compliance with guidelines.
• Tracks formulary requirements.
• Responds to third party payors, employers, internal staff, and physician questions.
• Maintains information on health plan guidelines.
• Provides training on plan requirements.
• Obtains Advance Beneficiary Notice (ABN) or Notice of Exclusions from Medicare Benefits (NEMB) if required.
• Ensures provider compliance with plan guidelines.
• Ensures confidentiality of patient and institutional information.
• Provides routine information to customers and relays information appropriately.
• Makes patient needs known and responds to inquiries.
• Prepares written reports.

Requirements

• High School diploma or GED.
• PREFERRED: Associate's degree.
• 6 months' experience in healthcare.
• BLS through the American Heart Association or the American Red Cross CPR for the Professional Rescuer with card in-hand before start date.

Pay

Pay is dependent on applicant's relevant experience. Pay range: $19.67 - $25.57 / hour.

Schedule

This position is an onsite role and does not offer a hybrid or remote option. Work Schedule: Full Time, 80.00 hours per pay period (2 weeks). Shift: Days.

Benefits

Employees are our number one asset. UCHealth promotes a culture that invests in professional success and personal well-being through a comprehensive total rewards program.

• Recognition Performance bonus: UCHealth offers a 3-Year Incentive Bonus to recognize employee contributions to our success in quality, patient experience, organizational growth, financial goals and tenure. The bonus accumulates annually each October and is paid out in October during the third year of employment.
• Performance-based pay increase: The Annual Merit Pay Increase recognizes work performance that meets or consistently exceeds performance standards documented through UCHealth's established evaluation process and accounts for increased experience, skills and cost of living.
• Market reviews: All UCHealth positions are reviewed annually to ensure UCHealth base pay aligns with market standards. Base pay rates are adjusted as needed to stay market competitive.

Health and well-being

• Medical, dental and vision coverage.
• Access to 24/7 mental health and well-being support for employees and dependents.
• Discounted gym memberships and fitness resources.
• Free Care.com membership.
• Voluntary benefits such as accident insurance, critical illness insurance, group legal plan, identity theft protection, pet insurance, auto and home insurance, and employee discount programs.
• Paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), leaves of absence.
• Employer-provided basic life and accidental death and dismemberment coverage with buy-up coverage options.
• Employer-provided short-term disability and long-term disability with a buy-up coverage option.

Retail and savings

• 403(b) plan with employer matching contribution.
• Additional 457(b) plan may be available.
• Flexible spending accounts for health care and dependent day care; health savings account available when enrolled in high-deductible (HD) medical plan.

Education and career growth

• Access to academic degrees and certificate programs to promote professional and personal growth.
• Up to 100% of tuition, books and fees paid for by UCHealth for specific educational degrees.
• Up to $10,000/year pre-paid by UCHealth or up to $5,250/year in the form of tuition reimbursement.
• Access to LinkedIn Learning, which offers thousands of virtual courses and seminars, and internal professional development opportunities.

Other programs

• We improve lives. In big ways through learning, healing, and discovery. In small, personal ways through human connection. But in all ways, we improve lives.