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Referral Specialist

4 months ago

OMAHA, United States CommonSpirit Health Full time

This is a remote position with the occasional need to go to the office for training.

 

The Referral Specialist works with patients requiring a referral, to ensure patient’s referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.


  • Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
  • Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.
  • Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
  • Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patient.
  • Enter referrals, documents communications and action into the system, as appropriate. 
  • Notify physician(s) and patient when referral is denied, or if additional information is needed.
  • Develop and maintain database of referral physician offices preferred by each physician within the clinic.
  • Assist Practice Manager with complaint resolution and solutions related to patient referrals.
  • Perform other duties as assigned by the practice manager or physician.

Required Minimum Knowledge, Skills, Abilities and Training

2 years of progressively responsible related experience in a 

Health care environment required.