Referral Specialist - Outpatient Imaging - Full-time

POSITION SUMMARY

Under the supervision of the office manager and/or Director, the Referral Specialist is responsible for processing referral orders by obtaining necessary prior/retro authorizations and ensuring safe, successful transitions of care for patients. Duties include written and verbal communication with insurance agencies, medical entities, providers, patients, and peers; maintaining accurate and complete patient records with clear and comprehensive documentation; and utilization of extensive knowledge of payor plans, diseases processes, radiology tests, and healthcare providers both locally and in surrounding communities.

QUALIFICATIONS

Required: To perform this job successfully, an individual must be able to perform each essential job function 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

TYPICAL PHYSICAL/MENTAL DEMANDS

While performing the duties of this job, the employee is required to sit or stand, walk, and reach. The employee must occasionally lift and/or move up to 15 pounds.  Specific vision abilities required by this job include close vision, ability to adjust focus, and view a computer monitor throughout the shift. The employee must be clear thinking and able to focus on work tasks amidst open office distractions and competing priorities. 

ESSENTIAL JOB FUNCTIONS

• Is consistently at work and on time, as established.


• Prioritizes referrals by urgency and addresses them in a timely manner. Uses time efficiently.


• Ensure complete demographic, insurance information and appropriate/pertaining clinical information is sent to referred servicing providers.


• Contacts insurance companies to ensure prior authorization requirements are met. Presents necessary medical information to insurance companies to prove the medical necessity of request.


• Research and locates out-of-area specialists as needed for referrals.


• Communications - Speaks clearly and professionally in positive or negative situations; listens and gets clarification; responds well to questions and feedback; participates in meetings; edits work for spelling and grammar; keeps others adequately informed; selects and uses appropriate communication methods.


• Keeps abreast of current developments; requires minimal supervision; displays understanding of how job relates to others; maintains confidentiality per policy and regulations.


• Fluent in Word, Excel, and Outlook as well as job-related software and computers; uses available resources effectively; adapts to new technologies; keeps technical skills up to date.


• Demonstrates competence in relation to the defined mission, vision, values, and strategic plan of the organization. Apparent by ongoing completion of any or all of the following: proficiency testing, skill demonstration, practice of core standards for service excellence, and documentation review.


• Ability to schedule patients to assist with workflows and work queues.

MARGINAL JOB FUNCTIONS

• Performs other duties as assigned.