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)
DEFINITION:
The Central Referral Center Specialist performs a variety of tasks that requires basic knowledge of systems and procedures. Under the direction of the immediate supervisor, the position is responsible for verifying insurance eligibility, obtain authorizations and referral requirements when necessary, scheduling, interviewing, and pre-registering all patients for procedures in various departments in the hospital and clinics. The Central Referral Center Specialist helps to ensure that patients flow through the scheduling and registration systems as quickly and efficiently as possible, while also ensuring all fiscal procedures are followed in a consistent manner.
PREFERRED QUALIFICATIONS:
Hospital/physician office experience
Intermediate level of communication and customer service skills
High School Diploma preferred
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