Senior Referral Specialist

1 month ago


Providence, Rhode Island, United States Lifespan Full time
About the Role

This position is responsible for ensuring the quality of the referral process, ensuring the integrity of prior authorization processes, and coordinating with patients and referring providers to secure insurance authorizations.

Key Responsibilities
  1. Receive and review incoming referrals, ensuring completeness and accuracy, and communicate promptly with referring providers and/or patients regarding insurance coverage issues.
  2. Confirm patient eligibility with insurance carriers and obtain pre-authorization requirements in accordance with established medical policies.
  3. Coordinate and ensure appropriate insurance authorizations are obtained and/or received in a timely manner.
  4. Evaluate and determine triage when reviewing referrals, following established clinic referral guidelines for complete and compliant information.
  5. Collaborate with Brown University Health personnel to resolve billing issues, authorization denials, and insurance denials/write-offs.
  6. Provide accurate and timely communication with patients, referring providers, and other staff.
  7. Perform at benchmarked levels related to accuracy, productivity, quality, and customer service as defined by industry standards and internal quality management.
  8. Document any communication with referring providers, patients, and/or Clinic (MD, RN, etc.) in the EHR.
Requirements

This role requires a High school degree or equivalent experience, with at least two years of clinical referral and medication prior authorization experience. Strong organizational skills, customer service and communication skills, and knowledge of the basic functions of a therapy/treatment plan and insurance portals are essential.

About Lifespan

Lifespan is an Equal Opportunity / Affirmative Action employer and values diversity in the workplace.


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