Referral Specialist jobs in Providence, RI

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. Additionally, Referral Specialist resolves pre-certification, registration, and case-related issues. Documents referrals, communications, actions, and other data in an information system. Generates and distributes all applicable forms, notifications, and paperwork. May require an associate degree. 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)

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Referral Specialist PD
  • Lifespan
  • Providence, RI OTHER
  • Summary:

    The Access and Referral Specialist reports to a Patient Access Supervisor. Under the general supervision ensures the quality of the referral process is upheld to departmental standards. Evaluates the incoming referral for information that is accurate and appropriately reflects the patient symptom to the requested treatment. Ensures quality control of the referral process is upheld by reviewing the accuracy and timeliness of referrals through monthly standard reports. Coordinates the effective and efficient processing and scheduling of all incoming referrals adhering to established timelines and departmental procedures.

     

    Responsibilities:

    Receives and reviews all incoming referrals ensuring completeness and accuracy. Ensures all information is received including patient demographics insurance and authorizations. Communicates promptly with referring provider and/or patient regarding insurance coverage issues (e.g. non-participation status) so the patient may seek timely services elsewhere.

    Evaluates and determines triage when reviewing the referral by following established clinic referral guidelines for complete/compliant information.

    Determines if referral is in need of additional clarification evaluates the content matter to services requested and determines if the referral needs to be escalated to management for assistance or resolution.

    Returns incomplete/non-compliant referrals based on triage guidelines to referring physician office indicating the reason for return.

    Ensures quality control of the referral process is upheld by reviewing the accuracy and timeliness of referrals through Monthly standard reports.

    Provides accurate and timely communication with patients referring providers and other staff.

    Performs at benchmarked levels related to accuracy productivity quality and customer service as defined by industry standards and internal quality management.

    Coordinates and provides guidance to Outpatient Service Representative (OSR) or other staff to ensure proper documentation is made in referral record. Assists and provides support to staff when entering all referral information into the electronic health record (EHR) for any external referrals received including demographics reason for referral and insurance/authorization information. Scans referrals received by fax and/or on paper into the appropriate section of the referral record.

    Documents any communication with referring providers patients and/or Clinic (MD RN etc.) in the EHR.

    Responds to incoming telephone calls regarding pending referrals including timely response to voicemail messages.

    Coordinates and provides support when scheduling all referral appointments established by practice protocols and specifically those that require prior authorization. Maintains current knowledge of insurer referral/authorization requirements have a working understanding of the patient population and demonstrate cultural awareness and sensitivity.

    Schedules appointments according to triage guidelines. Ensures all demographics information is updated insurance verified and authorizations obtained. Notifies patients of appointment explains and educates patient to a level of understanding for the preparation needed for the upcoming appointment. Communicates with referring providers and ensures documentation of that communication in the EHR.

    Documents any and all communication with patients in the EHR. Communicates with referring providers when patients decline appointments and/or do not keep their appointments. Refers patients to the Patient Financial Advocate when necessary.

    Acts as a liaison/resource with patients referring providers community providers and practice team members regarding referral issues utilizing the highest level of customer service.

    Consistently monitors clinic schedules to ensure maximized scheduling and fills any available/open timeslot including those appointments cancelled and/or rescheduled.

    Notifies Provider and/or Supervisor if unable to schedule referral or if there are access issues.

    Monitors Referral Work-Queues and ensures that all referrals have been processed accordingly.

    Performs other duties as assigned.

     

    Other information:

    BASIC KNOWLEDGE:
    Associate degree in health information technology or related field or the equivalent experience in an ambulatory setting.
    Formal education in medical terminology anatomy and other coding-related course.

    EXPERIENCE:
    Two years of clinical referral experience required and/or at least one year of related experience in coding/billing and medical record operations in an ambulatory care facility Health Information/Medical Record Department.
    Familiarity and understanding of the content of the medical record.
    Spanish speaking strongly preferred.
    Strong organizational skills with a proven ability to prioritize and handle frequent changes in workload and able to manage competing priorities.
    Excellent customer service and communication skills with the ability to discuss delicate matters with patients and referring providers required.
    Demonstrated knowledge and skills necessary to provide care to patients through the life span with consideration of aging processes human development stages and cultural patterns in each step of the care process.

    WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
    Work is performed in a typical medical office setting requiring extensive sitting standing and walking. Reads referrals for new patient appointments for the majority of a day. Ability to work under fast paced sometimes stressful conditions to process new patient referrals meeting productivity and accuracy metrics. Organized and able to manage competing priorities ability to use good judgment by showing resourcefulness in problem solving.

     

    Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

     

    Location: Rhode Island Hospital USA:RI:Providence

     

    Work Type: Per Diem

     

    Shift: Shift 1

     

    Union: Non-Union

  • 12 Days Ago

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HVAC Technician - East Providence, RI
  • Career and Referral
  • East Providence, RI FULL_TIME
  • At Trane TechnologiesTM and through our businesses including Trane® and Thermo King®, we create innovative climate solutions for buildings, homes, and transportation that challenge what’s possible for...
  • 2 Months Ago

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Referral Coordinator
  • The Providence Community Health Centers, Inc.
  • Providence, RI FULL_TIME
  • A Referral Coordinator works collaboratively with physicians, practitioners, counsellors, nurse case managers and other departments to coordinate transfer of care between PCHC providers and community ...
  • 7 Days Ago

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Referral Coordinator
  • Brown Dermatology
  • Providence, RI FULL_TIME
  • SUMMARY: Coordination of Routine Referrals would be managed centrally to develop a dedicated, trained staff to manage referrals. This would better prepare patients for visit with specialist. Processin...
  • 1 Month Ago

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Clinical Manager- Intraoperative Neuromonitoring
  • SpecialtyCare Associate Referral Program
  • Providence, RI FULL_TIME
  • SpecialtyCare continues to grow and we’d like you to grow with us. We are the industry leader in intraoperative neuromonitoring (IONM) services in the US—monitoring over 60,000 cases annually, providi...
  • 23 Days Ago

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IM Referral Coordinator
  • Day Kimball Healthcare
  • Putnam, CT FULL_TIME
  • Referral Coordinator Internal Medicine Cardiology Full Time First Shift Job Summary of Referral Coordinator: The Referral Coordinator is a multi-tasking position that consists of all aspects of the re...
  • 1 Month Ago

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0 Referral Specialist jobs found in Providence, RI area

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Training Specialist
  • Point32Health
  • Watertown, MA
  • Under moderate supervision, delivers technical training and soft-skills programs to entry-level and experienced staff. P...
  • 3/18/2024 12:00:00 AM

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Vehicle Crash/Automotive Expert
  • Robson Forensic
  • Providence, RI
  • Job Description Job Description VEHICLE CRASH EXPERT / AUTOMOTIVE EXPERT Do you want to use your training, education, an...
  • 3/18/2024 12:00:00 AM

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Vehicle Crash/Automotive Expert
  • Robson Forensic
  • East Greenwich, RI
  • Job Description Job Description VEHICLE CRASH EXPERT / AUTOMOTIVE EXPERT Do you want to use your training, education, an...
  • 3/18/2024 12:00:00 AM

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Sleep Expert - Sales
  • Mattress Firm
  • Franklin, MA
  • Now Hiring! Sleep Expert Sales This fast-paced, commission-driven sales role will provide you with everything you need t...
  • 3/14/2024 12:00:00 AM

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Sleep Expert - Sales
  • Mattress Firm
  • Newton Center, MA
  • Now Hiring! Sleep Expert Sales This fast-paced, commission-driven sales role will provide you with everything you need t...
  • 3/14/2024 12:00:00 AM

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Sleep Expert - Sales
  • Mattress Firm
  • Franklin, MA
  • Now Hiring! Sleep Expert – Sales This fast-paced, commission-driven sales role will provide you with everything you need...
  • 2/29/2024 12:00:00 AM

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Sleep Expert - Sales
  • Mattress Firm
  • Newton, MA
  • Now Hiring! Sleep Expert – Sales This fast-paced, commission-driven sales role will provide you with everything you need...
  • 2/28/2024 12:00:00 AM

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Sleep Expert - Sales
  • Mattress Firm
  • Newton, MA
  • Now Hiring! Sleep Expert – Sales Is your current job a nightmare? Make it a dream! Mattress Firm The most trusted author...
  • 2/23/2024 12:00:00 AM

The Providence city limits enclose a small geographical region with a total area of 20.5 square miles (53 km2); 18.5 square miles (48 km2) of it is land and the remaining 2.1 square miles (5.4 km2) is water (roughly 10%). Providence is located at the head of Narragansett Bay, with the Providence River running into the bay through the center of the city, formed by the confluence of the Moshassuck and Woonasquatucket Rivers. The Waterplace Park amphitheater and riverwalks line the river's banks through downtown. Providence is one of many cities claimed to be founded on seven hills like Rome. The...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Referral Specialist jobs
$42,196 to $51,907
Providence, Rhode Island area prices
were up 1.6% from a year ago

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