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)
Primary Objective
This employee is responsible for the processing of all incoming referrals. This employee is also responsible for answering the Provider Services Line (PSL) which is set up so that each of our Physicians and Referring Providers have direct contact with our referral staff throughout the day.
Essential Functions
Processing all incoming referrals within a 72-hour turn around period.
Able to process a minimum of at least 65 referrals per day.
Answering all incoming calls from PSL in a timely fashion.
Responsible for processing all prior day’s After Hours Call Backs.
Ensuring all work queues are within compliance.
Able to assist with Call Center volume as needed.
Adhering to all CEENTA policies and procedures
Ability to meet the physical and mental demands of the position.
The ability to work on-site, if/when needed.
Predictable, reliable, and prompt attendance.
Skills and Abilities
This employee must have both strong oral and written skills. Must be an active listener, be service oriented and possess excellent problem-solving skills.
Core Competencies
Patient Care / Professionalism / Teamwork Collaboration / Critical Thinking / Attention to detail /Able to understand & follow the On-call Provider schedule to ensure proper coverage.
Clinical Competencies
Strong interpersonal and communication skills and attention to detail. Building positive working relationships. Complex problem-solving capabilities.
Training Period
Training is completed in 2 to 4 weeks on site and then team member will transfer to working fully remote.
Accountability
Our mission is to be the premier eye, ear, nose, and throat group providing comprehensive, quality, and ethical healthcare to all in the Carolinas; to provide a favorable environment for the delivery of healthcare; and to provide for the wellbeing of the physicians and the employees of Charlotte Eye Ear Nose & Throat Associates, P.A.
Education
GED or High School Diploma is required.
Experience
At least 1 year of Customer Service/ Call Center experience is a must. Knowledge of Epic system and prior referral experience is a plus.
Certificates, Licenses, Registrations
N/A
Work Environment
The work environment characteristics described are representative of those an employee may encounter while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Supervisory Responsibilities
N/A
Position Type and Expected Hours of Work
Nonexempt position able to work 40 hours per week.
Physical and Mental Requirements
The physical and mental demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical Demands: Able to operate basic office equipment such as computers, phones, copier and fax machines as needed. Due to needs of the business, able to work both on and off site as needed.
Mental Demands: Able to perform well in a fast-paced environment. Critical thinking and problem-solving skills are needed to handle some complex patient inquiries. Attention to detail. Able to handle speaking with Physicians and other referring providers in a very confident and professional manner at all times.
Travel
Little to no travel but may be required due to needs of the business.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. In addition to those essential functions identified above, individuals in this position are also responsible for performing other duties or tasks that may be assigned. CEENTA retains the discretion to add or change the essential job functions of this position at any time without notice.
A Typical Day in the Position
This position requires someone who can answer all incoming calls from Physicians and referring providers in confident and professional manner. This employee must also be able to handle and assess urgent matters in a timely manner. This employee must be able to operate a multi-line phone system, work between 2 separate monitors and operate other basic office equipment such as a copier, printer and fax machine. This employee is also responsible for processing all incoming referrals via fax, email or phone call.
Equal Employment Opportunity Statement
The Company bases all applicant and employee employment decisions without regard to race, creed, color, religion, age, gender identity or expression, sexual orientation, pregnancy, genetic information, national origin, sex, uniform service, veteran status, protected disability, and any other category protected under federal or state law. This policy of equal employment opportunity applies to all policies and procedures relating to employment including, but not limited to recruitment, placement, employee training and development, promotion, benefits, compensation, leaves of absence, position elimination, layoff, recall, termination, and all other terms and conditions of employment. The Company opposes racial injustice and racial inequality. We strive to provide a diverse workplace wherever employee’s background and experiences are important and bring value to us as an organization. Employees should bring any violations of this policy to the attention of Human Resources.
The South Carolina Pregnancy Accommodation Act protects individuals from employment discrimination for medical needs arising from pregnancy, childbirth or related medical conditions. The Act, which amended the South Carolina Human Affairs Law, also requires that employers provide reasonable accommodations for medical needs arising from pregnancy, childbirth or related medical conditions. Should you have any questions, please contact Human Resources.
Accessibility Accommodation Statement Charlotte Eye, Ear, Nose and Throat Associates is committed to complying with all applicable provisions of the Americans with Disabilities Act, as amended (“ADA”), and applicable state and local laws. It is the Company’s policy not to discriminate against any qualified employee or applicant with regard to any terms or conditions of employment on the basis of such an individual’s disability. If you are an applicant and need a reasonable accommodation when applying for job opportunities within the Company or request a reasonable accommodation to utilize the Company’s online employment application, please contact hr@ceenta.com.
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