Referral Specialist OBGYN

About the role

Banner Health is creating a new model to address America’s health care challenges by making access and delivery easier, more affordable, and more reliable. As a Referral Specialist in our Chandler OB/GYN clinic, you will verify and update patient registration information, obtain benefit verification and authorizations, and ensure accurate insurance eligibility for specialty consultations and follow-ups. You’ll process roughly 50 referrals daily, attach necessary documentation to patient charts, and assist with phones as needed. This role offers daily opportunities to learn, grow, and make a meaningful difference in patient care.

Responsibilities

• Verify and update patient registration information in the system/chart.
• Obtain benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all specialty consultations and follow-ups.
• Use online, web-based verification systems and review real-time eligibility responses to ensure accuracy of insurance eligibility.
• Attach referrals and authorizations to patients’ charts for billing purposes.
• Process roughly 50 referrals per day.
• Assist with phones as needed.
• Schedule appointments for specialty physician services and diagnostic testing per provider request and communicate scheduling requirements to patients.
• Act as a liaison between patients, providers, and staff for referral and follow-up needs.
• Provide prompt and professional service by educating patients/families and assisting with external resources when needed.
• Provide all pertinent clinical information needed for payor authorization, the facility, or specialist prior to services being rendered by verifying coverage, obtaining authorization, and communicating with receiving facilities.
• Track and manage all referrals by monitoring outstanding referrals at 30/60/90-day intervals and following up with patients if appointments are not kept.
• Apply knowledge of medical terminology and maintain up-to-date knowledge of the insurance environment.
• Utilize internal and external resources to stay informed about regulations regarding various payor sources.
• Collaborate with outside referral sources and other community resources.
• Maintain an updated list of community resources and network with colleagues to develop additional referral sources.

Requirements

• High school diploma/GED or equivalent working knowledge.
• 1 year of direct patient interaction/experience in a medical, insurance, or healthcare-related industry.
• Knowledge of HIPAA regulations.
• Strong customer service focus and willingness to problem-solve.
• Effective verbal and written communication skills.
• Ability to manage competing priorities.
• Proficiency with commonly used office software.

Preferred Qualifications

• Previous knowledge of managed care concepts.
• Working knowledge of medical terminology and ICD-9 and CPT codes.
• Additional related education and/or experience.