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)
POSITION TITLE: Referral Specialist
LOCATION: Sonora, California
STATUS: Full-Time, Non-Exempt
POSITION SUMMARY:
Under the direction of the Referral Supervisor, the Referral Specialist is responsible for the referrals, diagnostic orders and surgery coordinating of patients to outside agencies, and the appropriate follow-up of those referrals per established policies and procedures.
The position requires an awareness and keen appreciation of American Indian traditions, customs, and socioeconomic needs and the ability at all times to meet and deal effectively in contacts with Indian health organizations which requires tact, courtesy, discretion, resourcefulness and good judgment in handling functions of a sensitive nature.
PRIMARY RESPONSIBILITIES:
1. Knowledge of EHR-EPM systems including Next Gen & i2i
2. Ability to visit sites within the organization for training and meetings.
3. Valid unrestricted California Driver’s license and the ability to be insurable under MACT’s automobile insurance.
MINIMUM QUALIFICATIONS:
AMERICAN INDIAN PREFERENCE:
Preference in filing of a vacancy will be given to qualified American Indian applicants in accordance with the Preference Act of 1934 (Title 25, U.S. Code, Sections 472 & 473) and Public Law 93-638, provided the applicant has submitted appropriate verification of Indian preference for employment. Other than the aforementioned requirement, the MACT Health Board, Inc. is an Equal Opportunity Employer.
NOTICE OF DRUG-FREE WORKPLACE ACT REQUIREMENT:
MACT Health Board, Inc. is required to implement the Drug-Free Workplace Act of 1988, 45 CFR Part 79, Subpart F. As such it is unlawful for employees to manufacture, distribute, dispense, possess, or use a controlled substance on the job site. Employees who are reasonably suspected of violating this act may be subject to drug testing as a condition of employment. Employer required fitness examinations shall include drug testing as evidence of employee and employer compliance with the Drug-Free Workplace Act.
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