REFERRAL SPECIALIST - FULL TIME

Description Summary/Objective

A Referral Specialist is responsible for obtaining insurance referrals, prior authorizations, and pre-determinations that allow a patient to access the services of the Clinic’s health care providers.

Essential Functions

• Complete daily workload assignments, keeping to the department standard for productivity, for obtaining authorizations, referrals, or pre-determinations for clinic patients.
• Accurately process authorizations, referrals, and predeterminations per insurance carrier guidelines and clinical specialty requirements.
• Accurately document all actions taken to obtain authorizations, referrals, and pre-determinations in Clinic systems. This includes building referrals and signing off on reservations.
• Maintain clear and positive communications with physician offices and support staff to ensure efficient handling of referrals, authorizations, and pre-determinations.
• Attends departmental meetings (including the daily huddle) and keeps the processes of your assigned specialties up to date.

Requirements

• Required Education and Experience: High School Graduate or equivalent (GED and 4 years of related experience may be equivalent).
• PREFERRED Education and Experience: One to two years referral, authorization, and pre-determination experience preferred. Prefer experience working with Epic, Athena/IDX, ICD-10, CPT / HCPCS codes, and proficiency with medical terminology.

Additional Eligibility Qualifications

• Knowledge of insurance plan referral requirements and referral processes.
• Ability to demonstrate excellent communication skills (oral and written).
• Ability to retain detailed information to perform daily duties and assist physician offices with proper referral processing.
• Ability to type 35wpm and have basic knowledge of IDX scheduling.
• Ability to multi-task in a fast paced environment and possess excellent organizational skills.
• Advanced telephone skills as a primary instrument of communication.