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)
Clinic Registration
Mora, MN
Professional
Full Time, Days, Mon- Friday, daytime hours, Mora location
Hours/Pay Period: 72
Posted 12/16/2022
Req # 2812
Job Title: Referral Specialist
Department: Clinic Services
SUMMARY
The Referral Specialist will manage requests for incoming/outgoing referrals and medication prior authorization. The Referral Specialist will provide information, problem solve, and coordinate efforts regarding Referrals and medication authorizations. The Referral Specialist will provide quality customer service to our patients, providers, co-workers and insurance companies by providing timely and accurate information.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
Associate degree/diploma/certification in related field. Proficient in Medical Terminology. Prior authorization experience preferred.
COMPUTER SKILLS
Working knowledge of current word processing and graphics software (Windows environment which may include: Word, Excel, Outlook, and PowerPoint). Proficient in Excellian and Meditec. Excellent typing skills, communication, and phone skills.
PHYSICAL DEMANDS
The physical demands described here 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.
While performing the duties of this job, the employee is frequently required to sit. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; and talk or hear. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, depth perception, and ability to adjust focus.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally exposed to fumes or airborne particles and toxic or caustic chemicals. The noise level in the work environment is usually moderate.
Performs a Class III job as classified by OSHA and may be exposed to Class III hazards.
Job Type: Full-time
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