Referral Specialist I/II

The Referral Specialist works with patients requiring a referral, to ensure patients referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.

II. Key Responsibilities

Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.

Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.

Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.

Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patient.

Enter referrals, documents communications and action into the system, as appropriate.

Notify physician(s) and patient when referral is denied, or if additional information is needed.

Develop and maintain database of referral physician offices preferred by each physician within the clinic.

Assist Practice Manager with complaint resolution and solutions related to patient referrals.

Perform other duties as assigned by the practice manager or physician.

Role-Specific Behaviors: these additional behaviors are necessary in the role:

Knowledge of clinic referral and scheduling processes and billing/authorization requirements.

Knowledge of federal and state pay requirements, including Medicare, DSHS, HMO/PPO Contracts.

Ability to communicate effectively and to maintain strict confidentiality.

Ability to respond to people and issues promptly and appropriately, to resolve problems.

A team player who handles multiple projects simultaneously in a fast paced environment.

Possess a strong work ethic and a high level of professionalism.

Skills, Knowledge or Abilities critical to this role:

Language Ability: Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to common inquiries or complaints from groups of managers, clients, customers, and the general public.

Math Ability: Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills: Must be proficient with the Microsoft Office Suite, Internet navigation, database management, desktop publishing, spreadsheet, and graphic presentation packages.