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)
Job Description Summary
The Referral Management Specialist I reports to the Digestive Health Patient Access Scheduling Supervisor. Under general supervision, the Referral Management Specialist serves as the initial point of contact for individuals and referring physicians seeking access and referral information for medical care at MUSC. This position facilitates the referral process and schedules appointments Digestive Health Providers. This role triages patient calls according to established algorithms, answers questions, resolves issues and refers to appropriate clinical team for clinical issues as appropriate. This position performs quality data collection of accurate information including demographic, physician, insurance, employment, next of kin, emergency contacts and other miscellaneous information needed to complete the patient’s information. This role performs activities to ensure effective operations of the clinics, while enhancing the revenue cycle and providing the highest level of customer service.Entity
Medical University Hospital Authority (MUHA)Worker Type
EmployeeWorker Sub-Type
RegularCost Center
CC000388 CHS - DDC Clinical (Digestive Disease Center) (ART)Pay Rate Type
HourlyPay Grade
Health-19Scheduled Weekly Hours
40Work Shift
Job Description
The Referral Management Specialist I reports to the Digestive Health Patient Access Scheduling Supervisor. Under general supervision, the Referral Management Specialist serves as the initial point of contact for individuals and referring physicians seeking access and referral information for medical care at MUSC. This position facilitates the referral process and schedules appointments Digestive Health Providers. This role triages patient calls according to established algorithms, answers questions, resolves issues and refers to appropriate clinical team for clinical issues as appropriate. This position performs quality data collection of accurate information including demographic, physician, insurance, employment, next of kin, emergency contacts and other miscellaneous information needed to complete the patient’s information. This role performs activities to ensure effective operations of the clinics, while enhancing the revenue cycle and providing the highest level of customer service.
Additional Job Description
A Bachelor’s degree from an accredited college/university; or a high school diploma or equivalent (GED) and two years experience in a Medical Office, Call Center, and/or customer service business environment required. The ability to prioritize and coordinate multiple tasks in a busy environment necessary. Extensive experience with computers and technology including Windows, Excel, and Intranet/Internet navigation tools, as well as system content, essential. Strong demonstrated verbal, written, problem solving and presentation skills. Ability to work in self-directed manner while interacting with customers, physicians and departmental partners.
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees
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