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)
The Referral Specialist/Medical Assistant assists in scheduling activities, referral activities, and assists physicians in the treatment of patients.
The Specialist obtains pre-certification from insurance companies for patients prior to a procedure or service. Multiple electronic systems are utilized including Allscripts, Paragon, Tangible, insurance verification tools, scheduling systems, and more.
QUALIFICATIONS:
The following qualifications are the minimum requirements necessary to adequately perform this job. However, any equivalent combination of experience, education and training which provides the necessary knowledge, skills and abilities would be acceptable, subject to any legal and/or regulatory requirements. Coding experience a plus.
A. Education: High school diploma or equivalent required.
B. Qualifications: Certified Nursing Assistants or Certified Medical Assistants are preferred, but individuals with an equivalent combination of education and experience will be considered. License/certification is not required for this position.
C. Work experience: Minimum two years experience working in a physician's practice desired.
D. Knowledge, skills and abilities required: Must have the ability to work independently, have strong communication skills, good basic math skills and be computer literate. Coding experience preferable. Knowledge and understanding of medical terminology is required. Ability to manage multiple tasks simultaneously. Customer service skills a must. A service oriented personality is required.
PHYSICAL AND ENVIRONMENTAL REQUIREMENTS:
Extended periods of time sitting and walking, bending and stooping may be required. Ability to do repetitive work, keyboarding and writing. Ability to work on a computer for extended periods of time. Has the ability to lift and move 15 pounds. Vision and hearing corrected to normal limits.
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