Referral Specialist jobs in Allentown, PA
Referral Specialist processes insurance pre-verification for hospital admissions or specialty service office visits. Gathers pertinent information from patients, insurance carriers, financial counselors, and other staff to confirm the patient's financial obligations for services. Being a Referral Specialist acts as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals. Verifies insurance coverage and obtains required authorizations when necessary. Additionally, Referral Specialist documents referrals, communications, actions, and other data in an information management system. Generates and distributes all applicable forms, notifications, and paperwork. Requires a high school diploma. Typically reports to a supervisor. The Referral Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Referral Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
Recently Added Referral Specialist jobs
Network Prior Authorization & Referral Specialist
- St. Luke's University Health Network
-
Allentown, PA
PART_TIME
-
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.The Network Prior Authorization and Referral Specialist is responsible for the coordination of prior-authorizations and referral process for patients being referred for specialty care, diagnostic procedures, and surgery. Performs scheduling, insurance verification, obtaining pre-authorizations, and referrals. Ensures notification of reimbursement to physicians, nurses, financial clearance staff, and patients prior to services being rendered.JOB DUTIES AND RESPONSIBILITIES:
- Obtains prior-authorizations and referrals from insurance companies prior to procedure or testing utilizing online websites or via telephone
- Monitors and updates current Orders and Tasks; managing Orders through Allscripts and Epic to provide up to date and accurate information
- Provides insurance company with clinical information necessary to secure prior-authorization or referral
- Works in alignment with Central Scheduling and Pre Encounter Departments.
- Obtains necessary electronic referrals needed from scheduled specialty appointments
- Obtains and/or reviews patient insurance information and eligibility verification to obtain prior-authorizations for diagnostic testing, medications, injections, DME, and surgeries.
- Request retro-authorizations when needed.
- Communicates with patient regarding the visit and prior-authorization process.
- Provides support to physician group and community practices with utilization issues.
- Works with community practices to obtain prior-authorizations.
- Communicates with practices when prior-authorization is unable to be obtained and requires peer-to-peer and/or different study.
- Documents in all systems prior-authorizations to ensure proper reimbursement
- Verifies and completes patient eligibility, coverage verification, and benefit investigation for the procedure using an online application or by telephone. If the patient is not eligible on date of service or procedure is not covered, this information is relayed to the physician and the patient
- Responds to written and telephone inquiries from patients, insurance carriers and facilities regarding planned services.
- Takes an active role in facilitation team approach to functions within the department:
- Attends departmental meetings
- Actively participates as a team member in resolution of problems as they are identified
- Analyzes current procedures, bringing suggestions for improvement to the attention
- Contacts Central Scheduling, Patient Access Department, and patient, to relay precertification information
- Notify ordering physician of any prior auth denials and peer to peers to be scheduled
- Review and validate the accuracy of therapy plan/treatment plans ordered by reviewing H&P and medical records to ensure medication ordered is the same as what is being prior authorized
- Validate medication ordered is on the payer preferred drug list
- Identify buy and bill authorizations vs. delivery and document account accordingly
- Review and follow up on authorization denials and claim denials
PHYSICAL AND SENSORY REQUIREMENTS:Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephones, data entry, etc. Occasional twisting and turning. Uses upper extremities to lift and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve files. Hearing as it relates to normal conversation. Seeing as it relates to general vision. Visual monotony when reading reports and reviewing computer screen.EDUCATION:High School diploma or equivalent required.TRAINING AND EXPERIENCE:One to two years of experience in medical billing office, medical setting or insurance company. Working knowledge of medical business office procedures and basic accounting and detailed understanding of ICD-10 and CPT codes. Strong knowledge of regulatory standards and compliance requirements. Previous pre-certification experience helpful. Previous Medical Assistant experience highly desirable.Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!St. Luke's University Health Network is anEqual Opportunity Employer. -
- 29 Days Ago
Surgical Neurophysiologist
- SpecialtyCare Associate Referral Program
-
Allentown, PA
FULL_TIME
- Passionate, driven people dedicated to making a difference in healthcare. SpecialtyCare continues to grow and we’d like you to grow with us. We are the industry leader in intraoperative neuromonitorin...
- 15 Days Ago
To Go Specialist
- Olive Garden
-
Easton, PA
OTHER
- For this position, pay will be variable by location - See additional job details and benefits below.Our Winning Family Starts With You! Check out these great benefits!Flexible schedules to help you ba...
- 13 Days Ago
Fit Specialist
- Emmaus Run Inn
-
Emmaus, PA
FULL_TIME,PART_TIME
- The ultimate goal of a fit specialist is to help guests achieve their fitness goals through the proper running shoe and gear. A fit specialist will need to provide a top-notch, in-store experience for...
- 14 Days Ago
Behavioral Specialist
- Kaleidoscope Family Solutions, Inc.
-
East Stroudsburg, PA
CONTRACTOR
- $250 sign-on bonus!!!Come create a colorful difference with Kaleidoscope Family Solutions (KFS)!!!Kaleidoscope Family Solutions, Inc. provides community and home-based services to persons with autism ...
- 15 Days Ago
Fufillment Specialist
- Radial, Inc.
-
Allentown, PA
FULL_TIME
- Fulfillment Specialist At Radial, our employees are at the forefront of ecommerce, bringing beloved brands to consumers through our fulfillment, customer care and technology solutions. We are fueling ...
- 15 Days Ago
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0 Referral Specialist jobs found in Allentown, PA area
Sleep Expert
- Mattress Firm
-
Reading, PA
- Is your current job a nightmare? Make it a dream job at Mattress Firm®! Join Mattress Firm as a Sleep Expert® and have t...
- 4/23/2024 12:00:00 AM
Client Service Specialist
- Recruiting Industry Specific Experts, LLC
-
Fort Washington, PA
- A Fee-Based RIA, Nationally Renowned as a Fastest Growing Privately Held Firm three years in a row, is looking for excep...
- 4/22/2024 12:00:00 AM
SAP Productions Planning Expert
- Top Stack
-
Wayne, PA
- Hybrid role - 2 days in the office This Senior Business Process Analyst – PP designs, delivers, and supports IT solution...
- 4/21/2024 12:00:00 AM
CMMS Implementation Specialist
- Information Professionals Inc
-
Whitehouse Station, NJ
- Job Description Job Description Location: Virtual We are looking for a motivated, talented and results-driven Implementa...
- 4/20/2024 12:00:00 AM
Technical Operations Specialist
- Artech LLC
-
West Point, PA
- Technical Operations Specialist West Point, PA Project Description: The Specialist is responsible for technical support ...
- 4/19/2024 12:00:00 AM
Sleep Expert - Sales
- Mattress Firm
-
Newtown, PA
- Now Hiring! Sleep Expert – Sales Is your current job a nightmare? Make it a dream! Mattress Firm The most trusted author...
- 4/12/2024 12:00:00 AM
Sleep Expert - Sales
- Mattress Firm
-
Easton, PA
- Is your current job a nightmare? Make it a dream job at Mattress Firm®! Join Mattress Firm as a Sleep Expert® and have t...
- 4/10/2024 12:00:00 AM
Sleep Expert - Sales
- Mattress Firm
-
Trexlertown, PA
- Is your current job a nightmare? Make it a dream job at Mattress Firm®! Join Mattress Firm as a Sleep Expert® and have t...
- 4/5/2024 12:00:00 AM
About Allentown, Pennsylvania
Allentown (Pennsylvania Dutch: Allenschteddel) is a city located in Lehigh County, Pennsylvania, United States. It is Pennsylvania's third most populous city and the 231st largest city in the United States. As of the 2010 census, the city had a total population of 118,032 and is currently the fastest growing city in all of Pennsylvania. It is the largest city in the metropolitan area known as the Lehigh Valley, which had a population of 821,623 residents as of 2010[update]. Allentown constitutes a portion of the New York City Combined Statistical Area and is the county seat of Lehigh County. ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Referral Specialist jobs
$40,741 to $50,017
Allentown, Pennsylvania area prices
were up 1.5% from a year ago
were up 1.5% from a year ago
What does a Referral Specialist do?
Referral Specialist in Terre Haute, IN
This position serves as the centralized intake for all internal referrals to core service programs.
December 12, 2019
Referral Specialist in Albany, NY
The Information and Referral Specialist 1 is the entry level classification which gathers information on community resources and utilizes a broad knowledge of the community resource network to make appropriate referrals to service providers.
December 01, 2019
Referral Specialist in Florence, AL
As a Referral Specialist you will execute patient insurance referrals, consultations, and diagnostic procedures relating to Kadlec Clinic.
January 14, 2020