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. Additionally, Referral Specialist resolves pre-certification, registration, and case-related issues. Documents referrals, communications, actions, and other data in an information system. Generates and distributes all applicable forms, notifications, and paperwork. May require an associate degree. 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)
Western Michigan University Homer Stryker M.D. School of Medicine is seeking a Referral Specialist. The referral specialist is responsible for assembling information concerning patient's clinical background and referral needs. Provides appropriate clinical information to referring providers, specialists, or health care facilities.
• Verifying insurance in the EMR and/or appropriate websites.• Pre-registration for upcoming appointments.• Manages all assigned work-ques and in-basket request.• Answers and directs department phone calls.• Schedules and reschedules referral appointments.• Enters patient demographic, referral, and insurance information into the EMR.• Verifies eligibility of managed care patients.• Checks and updates referral information.• Sorts and distributes department mail.• Provides information to patients regarding billing processes and procedures.• Ensures patients are notified for upcoming appointments by communicating through their My Chart, email or via US mail.• Ensuring all necessary new patient paperwork and health history questionnaires are mailed to all New Patients to WMed Health Providers/Specialists.• Manages patient portal requests.• Monitors office supplies and reorders items as needed.• Participates in all departmental meeting and in service trainings.• Availability to work occasional overtime on weekends or evenings to complete time sensitive projects.• Acquires knowledge for new technology and policy/procedure revisions.• All other duties as assigned.
• High school diploma or GED required.• Knowledge and proficiency in grammar and spelling skills preferred.• Healthcare setting experience preferred.• Customer service experience preferred.• Ability to type 40 words per minute with minimal errors required.• Knowledge and proficiency of EMR (Epic), Medifax, Access, WebDenis system, CHAMPS, and internet as required by department a plus.
• Knowledge of basic word processing and file management using Microsoft Office.• Knowledge of basic medical terminology a plus.• Ability to operate automated standard office equipment such as multi-line phone system, copier, fax machine, shredder, etc.• Ability to interpret, comprehend, and transmit complicated and detailed instructions accurately.• Demonstrates the ability to recognize priorities in organization of work flow.• Strive to work independently.• Bilingual a plus.• Make decisions based on established procedures.• Strives to learn more and is receptive to new challenges and opportunities.• No attendance/tardiness issues or concerns.• Participates in professional development classes.
About Western Michigan University Homer Stryker M.D. School of Medicine (WMed)
We are committed to excellence and health equity through transformative medical education, high-quality, patient- and family-entered care, innovative research, and community partnerships within a just culture of diversity, equity, inclusion, and belonging. Our vision is health equity for all in Southwest Michigan through innovation in the practice and study of medicine.
The medical school is a collaboration of Western Michigan University and Kalamazoo's two teaching health systems, Ascension Borgess and Bronson Healthcare. The medical school is a private nonprofit corporation supported by private gifts, clinical revenues, research activities, tuition, and endowment income. Building upon a $100 million foundational gift in 2011, WMed is a recipient of the Empowering Futures Gift, a philanthropic commitment of $300 million to support the mission of the medical school. WMed contributes to the economic vitality of Southwest Michigan through the services we provide as well as the creation of 1,600 new jobs and an annual estimated economic impact of $353 million in Kalamazoo and Calhoun counties.
WMed is fully accredited by the Liaison Committee on Medical Education and the Higher Learning Commission. The medical school offers a comprehensive, innovative four-year Doctor of Medicine degree program and two Master of Science degree programs in Biomedical Sciences and Medical Engineering. We train physicians in 10 residencies and five fellowships accredited by the Accreditation Council for Graduate Medical Education. To support our educational mission, we have Joint Accreditation for interprofessional continuing education, which incorporates accreditation by the Accreditation Council for Continuing Medical Education.
WMed Health is the clinical practice of the medical school with more than 300 providers offering comprehensive primary care and specialty services in several locations throughout Kalamazoo, Portage, and Battle Creek. The Department of Pathology faculty serve as the Office of the Medical Examiner for counties throughout Michigan and northern Indiana.
The W.E. Upjohn M.D. Campus located in downtown Kalamazoo serves as the primary educational facility with faculty and administrative offices, student study and social spaces, team-based learning halls, a state-of-the-art Simulation Center accredited by the Society for Simulation in Healthcare, basic science research labs, as well as toxicology and forensic pathology labs.
WMed is building upon Kalamazoo’s century-long foundation of drug discovery and medical device development with a strategic investment in clinical, laboratory, community, and educational research. The Center for Immunobiology, Center for Clinical Research, Research Histology Lab, Innovation Center, and Human Research Protection Program contribute to the medical school’s advancement of knowledge through innovation and discovery.
Western Michigan University Homer Stryker M.D. School of Medicine is an Equal Employment Opportunity/Affirmative Action employer of females, minorities, individuals with disabilities, and protected veterans, and actively strives to increase diversity within its community. We provide a drug- and tobacco-free workplace.
EEO Minorities/Women/Disabled/Protected Veterans.
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