Referral Specialist jobs in Pittsfield, MA

Description

Northern Berkshire Pediatrics, LLP., an experienced, dedicated and family-focused pediatric practice, is seeking candidates to fill an upcoming Referral Specialist vacancy on our team. Northern Berkshire Pediatrics is a Pediatric Physicians’ Organization at Children’s (PPOC) affiliated primary care practice.

The successful candidate will become an integrated member of our Billing team. This individual will be responsible for receiving, processing, and documenting patient referrals. In collaboration with the patient/family and primary physician, the Referral Specialist initiates the referral process through timely and professional communication with external specialty offices on behalf of patients. Candidates should have a thorough understanding of the referral process and insurance requirements to best assist and support the continuation of care for our pediatric patients. 

Referral Specialist responsibilities include (but are not limited to):

• Communicate and collaborate with Primary Physician and clinical team on patient referrals 
• Develop good working relationships with referral sources/outside agencies/specialty offices to best communicate and collaborate to facilitate specialist care
• Provide and thoroughly explain the initial referral process and information to families with compassionate, professional and timely service
• Provide assistance during clinical visits, follow up on CC’d charts, and respond to in-basket messages from providers      
• Initiate and maintain accurate, timely and complete documentation into patient charts using EMR system
• Review insurance requirements to ensure prior approval requirements are met and process prior authorizations as required for outside specialist referrals
• Assemble information ensuring complete and accurate registration, including patient demographics, current insurance, clinical background, referral needs and assist with booking appointments 
• Provide necessary medical information only as it relates to referral needs in accordance with HIPAA requirements
• Maintain ongoing tracking and appropriate documentation through the “Close the Loop” report on outstanding referrals including requesting and receiving consult notes and medical histories from health care providers as needed from referred consults
• Send new order requests for physical, occupational, and speech therapies every 30 days
• Participate in behavioral health and clinical meetings as needed
• Cross-train and serve as a back up to other areas in billing such as medical records, claims processing, eligibility, etc. 

The ideal candidate will possess the following skills:

• Excellent computer skills with ability to learn our EMR system
• Excellent written and verbal communication skills 
• Professional and positive attitude with the ability to provide quality care by communicating clearly and effectively with patients, families and caregivers
• Team-player with the ability to be flexible and collaborate with others (internally and externally) as well as work independently 
• Detail oriented, exceptional time management and organizational skills with the ability to multi-task and work under pressure
• Strong decision making and problem-solving skills 

Requirements

Requirements and Qualifications:

• High school diploma or equivalent required
• 1 years of prior experience working in the healthcare field as a Referral Specialist or similar role (medical assistant) preferred
• Ability to handle sensitive medical information and maintain confidentiality in accordance with HIPAA privacy laws
• Strong customer service experience and a proven track record in a fast paced, multitasking environment with strong prioritization skills needed
• Familiarity with medical terminology, medical records, insurance requirements and regulations

Current schedule is Monday through Friday, 8:30a - 5:00p. 

Interested candidates should submit resume and letter of interest when applying.

Northern Berkshire Pediatrics provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.