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)
This Referral Specialist is responsible for managing and coordinating specialty referrals, test orders, prior authorizations and is responsible for the necessary follow-up for the patient in collaboration with the provider in relation to these activities. This individual must be capable of appropriately prioritizing and organizing tasks related to patient care. The Referral Specialist must poses the ability to concentrate, listen, problem solve, and communicate effectively and must demonstrate excellent customer service skills consistently. The Referral Specialist is expected to support the Center’s mission and values and adhere to HKH policies and procedures, as well as applicable state and federal regulations. The Referral Specialist is expected to consistently demonstrate excellent interpersonal skills, teamwork and customer service skills and act in a supportive role as part of the patient care team.
REPRESENTATIVE DUTIES
The following duties are typical for the Referral Specialist. Incumbents may not perform all of the listed duties and/or may be required to perform additional or different duties from those set forth below to address business needs and changing business practices.
EDUCATION, EXPERIENCE & QUALIFICATION GUIDELINES
Any combination of education and experience that would likely provide the required knowledge and abilities is qualifying.
PHYSICAL DEMANDS AND WORKING ENVIRONMENT
The conditions herein 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 job functions.
Working Conditions: Medical office environment. Multi-task oriented position including direct patient care may require sitting or standing for long periods. Some bending, stooping, and lifting (up to 50lbs). Must interact with physicians, patients and other office personnel. Must possess socio-economic and cultural sensitivity. May involve contact with angry, upset or ill persons. Will involve potential exposure to blood and body fluids and other hazardous substances. Must have visual acuity and manual dexterity to assist with procedures, perform and interpret lab results, and interface with computer. Must have auditory acuity to handle phone calls and extensive patient interaction.
Work Schedule: This is a non- exempt position. The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria considered necessary to successfully perform the job.
Confidentiality: As an employee of Hamakua-Kohala Health Clinic, you are bound by principles of medical ethics. You have both a legal and moral obligation to protect the privacy of our patients. In the course of your work, you will have access to confidential information regarding patients, and/or the practices’ confidential business. It is essential that you refrain from any discussions regarding personal information about a patient, a patient’s condition, a patient’s finances, proprietary company information, personnel salaries, and/or the practices’ confidential business with any third person. This includes, but is not limited to, other employees, your spouse, family or friends. CONFIDENTIALITY IS SO IMPORTANT THAT ANY BREACH OF THIS POLICY WILL BE CONSIDERED GROUNDS FOR TERMINATION. Review and signature of the Agreement is a condition of employment.