Referral Specialist - Medical Group Admin - Specialty Care * Days - Resource en umhealthwest

Referral Specialist - Medical Group Admin - Specialty Care * Days - Resource

Requisition #: req11186

Shift: Days

FTE status: 0

On-call: No

Weekends: No

General Summary:

Under the direction of management, the Referral Specialist coordinates internal and external referrals ordered by providers. This includes completing referrals, scheduling appointments, acquiring and verifying third party information for authorizations and tracking referrals. The Referral Specialist works closely with physicians and other members of the care team.  

Requirements:

• High School education or equivalent
• One year of experience in a medical office and/or prior experience coordinating referrals
• Knowledge of medical terminology
• Able to work independently and collaboratively with minimal supervision
• Knowledge of medical record content and sequence
• Training or experience in medical coding and managed care insurance plans
• Knowledge of appointment scheduling process
• High level of interpersonal skills
• Communicate effectively, both verbal and written
• Able to prioritize, maintain accurate records, and work under deadline
• Excellent customer service skills

Essential Functions and Responsibilities:

1. Schedules and coordinates specialist appointments, procedures and tests done internally or externally.
2. Monitors EMR orders to ensure providers enter information correctly.
3. Validates insurance coverage and processes insurance authorizations.
4. Assembles information concerning patient’s clinical background and referral needs.
5. Enters and tracks all referral requests in the EMR or other information system as required
6. Responds and documents requests from providers and patients in a timely manner.
7. Participates in process improvement activities to enhance referral process and workflow.
8. Performs other duties as assigned. These may include but are not limited to: Maintaining a current knowledge base of department processes, protocols and procedures for patient care, pursuing self-directed learning and continuing education opportunities, and participating on committees, task forces, and work groups as determined by management.