Referral Specialist

GENERAL SUMMARY:

The Referral Specialist is responsible for the coordination, processing and scheduling of medical referrals and prior authorizations for a variety of medical or surgical services/procedures for clinic patients, as requested by clinical providers in a centralized call center environment. This requires clinical knowledge and understanding of CPT and ICD-9(10) codes to meet the requirements of third party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorization for multiple providers in multiple locations. Collaborates with other Clinic Referral Specialists, Providers, MA's, Scheduler/Receptionist and other support staff in multiple clinic locations. This position requires the use of clinical and administrative judgment and initiative to determine the best approach for both urgent and non-urgent patient care needs. Processes medical record requests pertaining to the referral itself, obtaining proper authorization as needed. Serves as a liaison between patients and medical office support staff in regards to referrals and appointment scheduling.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES :

All essential functions must be performed. Reasonable accommodations may be made to enable individuals with qualified disabilities to perform the essential functions.

• Assists patients in a prompt, courteous, and efficient manner.

• Serves as liaison between the insurance company, the patient and physician office.

• Directs the patients to the appropriate specialist and vendors according to their insurance

• Takes accurate and legible messages, which include time, date and other important details

• Answers non-clinical questions for patients and routes all other calls correctly.

• Obtains physician approval for referrals and hospital admissions.

• Contacts insurance company for referral number or pre-certification/authorization.

• Schedules outpatient procedures/tests and notifies patient of appointment and referral number the same day it is obtained.

• Completes referral timely.

• Utilizes third party payer/insurance portals; has a detailed knowledge of insurance providers, their portals and their expectations for authorization approval

• Requests medical records from specialists or hospital to process the referral or hospital authorization.

• Follows up with the insurance company regarding the status of the authorization.

• Understands guidelines for and appropriately uses the telephone system

• Faxes referrals to the specialists

• Utilizes EMR functions to document all pertinent information.

• Organize and prioritizes workload based on acuity

• Maintains confidentiality by following all applicable HIPAA regulations

• Must be willing to float to other HP practices, within reason, when patient load, vacation schedules etc. make it necessary

• Completes special projects or performs other duties as assigned

Qualifications
KNOWLEDGE AND SKILLS REQUIRED :

• Computer skills

• Physician office billing, registration or scheduling experience

EDUCATION AND EXPERIENCE REQUIRED :

• Minimum of a High School Diploma or Equivalent

EDUCATION AND EXPERIENCE PREFERRED:

• One (1) year of ICD-9 and CPT-4 coding experience

• Medical Assistant

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