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Referral Specialist

1 month ago

Kearney, United States Chi Full time
Overview

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.

Responsibilities
  • 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.
Qualifications

Qualifications
  • High school diploma or equivalent required.
  • 2 years of progressively responsible related experience in a healthcare environment required.