Referral Specialist (4538)

PRIMARY DUTIES:

• Initiates and manages all components of clinical referrals for various services
• Coordinates flow of information between medical clinic and referral authorization department to secure valid referrals timely for clinic patient
• Schedules and notifies patients of all applicable appointments
• Verifies insurance coverage and obtains authorizations, if needed, from insurance plans
• Notifies registration staff to update insurance coverage as needed
• Maintains proper documentation and management of the pre-authorization/referral information (faxing, scanning, etc.)
• Documents clear information in Referral Notes on any transactions pertaining to referral or authorization processes using correct spelling and grammar skills
• Learns and implements all policies and protocols as directed
• Keeps informed of changes and updates for insurance plan policies for Authorizations and Referrals
• Complies with all regulations related to patient confidentiality
• Able to manage multiple priorities and manage stress appropriately
• Communicates appropriately and clearly with a pleasant and professional manner to all
• Demonstrates excellent judgment in handling situations not covered by written or verbal instructions
• Demonstrates a commitment to the mission, core values, and goals of Family Health Center and its healthcare delivery including the ability to deliver exceptional patient focus with quality, compassion and respect

OTHER DUTIES:

• Cover duties of co-workers as needed

• Other duties as assigned

PHYSICAL AND MENTAL REQUIREMENTS:

• Visual and auditory accuracy
• Shift length – 8 hours
• Indoor setting
• Continuous use of computer and calculator
• Long periods of sitting
• Frequent use of telephone
• Continuous repetitive grasping and manipulation of both hands
• Continuous conversational communication
• Occasional lifting and carrying of up to 10 lbs.
• Occasional standing, reaching, walking, bending, and twisting
• Infrequent use of personal transportation
• Occasionally working in noisy, confined areas
• Understand/carry out simple/detailed, oral/written instructions
• Memorize and retain instructions
• Read and interpret detailed specifications

Qualifications

EDUCATION:  High school diploma or equivalent required, College Hours and/or Referral/Authorization Experience preferred, Bilingual in Spanish and English helpful

REPORTS TO:  Director of Billing Services

SKILLS:  Computer literacy, Excel, Medical Terminology, Knowledge of ICD-10/CPT coding, Medical office billing and collection practices, Federal/state/local financial assistance programs, Strong interpersonal, oral and written communication, Excellent telephone skills and strong customer service focus