Referral Specialist F/T Day

About the Role

Provides patients a seamless entry into the Prisma Health experience. Interfaces with patients and physician office team members to accurately authorize various consultations, procedures, and tests. Utilizes each patient’s preferred method of contact and various electronic medical records to transmit required clinical documentation to third-party payors and specialist physicians.

Responsibilities

• Documents all actions and encounters regarding the referral, including timely follow-up with the patient, referring and referral physician practices, and third-party payors (e.g., pre-certification, cancelled and rescheduled appointments, and other events preventing closure of the referral).
• Handles the authorization/precertification process by coordinating with outside and internal organizations and insurance companies to ensure prior approval requirements are met.
• Presents necessary medical information such as history, diagnosis, and prognosis to financial services to maximize reimbursement.
• Records demographic, coverage, and scheduling information in various systems and reminds patients of scheduled appointments via mail, internet, or telephone.
• Ensures the patient’s primary care chart is up-to-date with scheduling information about specialist consults, tests, and procedures.
• Alerts management to trends in appointment availability and timeliness.
• Promotes hospital goals toward meaningful use in the electronic medical record on behalf of the referring physician.
• Documents referral status and all scheduled appointments in the appropriate system for referral tracking data.
• Follows up after patient consultations, procedures, or tests to determine if the physician has received the report and continues checking until complete.
• Serves as a liaison between the provider, practice, patient, and specialist, providing appropriate clinical information and referral needs.
• Verifies physician’s orders to ensure accuracy of results and communicates guidelines, protocols, and location details to the patient.
• Assists patients in problem-solving potential issues related to navigating the healthcare system, financial obligations, or social barriers (e.g., arranging interpreters, transportation, or prescription assistance).
• May advocate on the patient’s behalf with carriers to ensure timely approval of necessary supplies or services.
• Responds to patient scheduling requirements, questions, and concerns to meet or exceed patient experience expectations.
• Ensures timely appointments are booked and reviews referral process details with patients.
• Maintains patient confidentiality and complies with HIPAA and Prisma Health’s compliance guidelines.
• Ensures effective and efficient facility operation to create an extraordinary experience for patients, physicians, and team members.
• Performs other duties as assigned.

Requirements

• High school diploma or equivalent preferred.
• Two (2) years of related work experience.
• Experience in a physician front office, including patient registration, electronic scheduling, and the authorization/precertification process, is preferred.
• In lieu of the above, equivalent work experience or an Associate degree (or higher) may be considered.

Skills

• Customer service skills.
• Strong communication and interpersonal skills.
• Knowledge of various health insurance companies.
• Knowledge of medical terminology, CPT and diagnosis coding, insurance verification, and the authorization/precertification process.
• Proficiency in Microsoft Office products.

Schedule

Day shift.