Referral Specialist - Over the Mountain Pediatrics

Key Responsibilities

• Manage the full referral lifecycle, including obtaining necessary documentation, securing insurance authorizations, and accurately documenting all actions in accordance with departmental and Medical Home standards.
• Prioritize referrals based on urgency and departmental guidelines, ensuring timely processing and adherence to established timelines.
• Serve as the primary point of contact, effectively communicating referral status, progress, and appointment details to patients and referring physicians.
• Carefully coordinate appointments with specialist clinics and ensure patients receive comprehensive information regarding their referrals and scheduled appointments.
• Monitor and track the status of all referrals, verify appointment completion, and ensure timely receipt of consultation notes.
• Facilitate the closure of the referral loop by forwarding completed notes to referring physicians.
• Obtain and distribute relevant information such as downloading and forwarding PHIL sheets (patient calls to our after-hours services) to the patient’s primary care provider.
• Provide regular updates to physicians and management on open and pending referrals, outstanding consultation notes, and specialty wait times.
• Address patient and specialist inquiries, resolve concerns, and provide exceptional customer service.
• Provide cross-functional support as needed, including call center and front desk support.

Requirements

• High School graduate or equivalent.
• 3 years of healthcare administrative experience.
• 1 or more years of healthcare referral process and insurance process experience.
• Knowledge of various insurance company processes, diagnosis coding, and other duties required to provide quality care to our patients.
• Excellent customer service skills and enjoyment of working with the public.

Qualifications

• Must have knowledge of various insurance company processes, diagnosis coding, and other duties required to provide quality care to our patients.
• Must have excellent customer service skills and enjoy working with the public.

Skills

• Excellent communication and interpersonal skills.
• Ability to prioritize tasks and manage time effectively.
• Strong organizational and attention to detail skills.
• Proficiency in healthcare software and systems.

Benefits

N/A

Pay

N/A

Schedule

Monday - Friday, occasional Saturdays (half day), Day Shift, Monday-Friday Standard Days