Referral Specialist OBGYN

Primary location: 1125 S Alma School Rd, Suite 210, Chandler, AZ 85286

About the role

As a Referral Specialist, you will verify and update patient registration information in the system/chart. You will 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. You will attach referrals and authorizations to patients’ charts for billing purposes, process roughly 50 referrals a day, and assist with phones as needed.

This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a primary care practice. You will provide all pertinent clinical information needed for payor authorization and the facility or specialist prior to services being rendered. The role involves tracking and managing all referrals to close patient care gaps and providing documentation to promote team awareness.

You will join an engaging team with definite potential for growth in our ever-growing GYN clinic, working side by side with medical staff to create a great patient experience. A love for working with adult patients over the phone is a plus.

Responsibilities

• Schedules appointments for specialty physician services and diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements.
• Acts as a liaison between patients, providers, and staff members for patients’ referral and follow-up needs.
• Provides prompt and professional service for patients by assisting in educating patient/family and helping patients with external resources when needed.
• Provides 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.
• Tracks and manages all referrals by monitoring outstanding referrals at 30/60/90-day intervals and following up with patients if appointments are not kept.
• Applies knowledge of medical terminology and maintains up-to-date knowledge of the insurance environment. Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources.
• Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources.

Requirements

• High school diploma/GED or equivalent working knowledge.
• One 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 and the ability to manage competing priorities.
• Proficient 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.

Schedule

Monday–Friday, 7:30 AM–4:00 PM

Benefits

Banner Health has been recognized by Becker’s Healthcare as one of the 150 top places to work in healthcare and by Newsweek as one of America’s Greatest Workplaces 2023 for Diversity. These recognitions reflect Banner Health's investment in team members' professional development, wellness benefits, and continued education. The organization highlights its commitment to advocating for diversity in the workplace, promoting work-life balance, and boosting employee engagement.