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)
Northern Light Mercy Hospital
Department: Physician Practice Central Ops
Position is located: Mercy Westbrook
Work Type: Full Time
Hours Per Week: 40.00
Work Schedule: No Hours Assigned
Summary:
The Referral Specialist provides administrative support to coordinate managed care referrals from primary care physicians, specialty outgoing referrals and ancillary services. Serves as a point person for all managed care issues. The incumbent performs duties and tasks in accordance with standards established for the job. The incumbent may have access to highly confidential patient, employee and/or proprietary information, and must handle & protect the information in accordance with hospital & system policies, HIPAA requirements and the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, or other security risks to the organization. The incumbent is responsible for participation in and completion of all patient safety initiatives appropriate to the position, and conducts all job responsibilities according to the Mission and Values of Hospital.
Responsibilities:
1. Information Systems Responsible for referral tracking (paper/computer/internet). Handles lost/retroactive referrals to help eliminate billing problems for patients, insurance companies, PCPs and Specialty office. Organizes and maintains managed care reports as indicated. 2. Collaborates and works efficiently with members of the healthcare team. Assists PCP/Specialty Provider in completing the referral accurately. Liaison with insurance company, Office Manager, and PCPs. Liaison between insurance companies and patients with resolutions to problems. Schedules appointments, outside imaging for patients; completes referrals. Sends reports and medical records pertinent to appointment to specialist in a timely manner.
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Education
Working Conditions