Referral Specialist jobs in Rhode Island

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)

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Referral Specialist PD
  • Lifespan
  • Providence, RI OTHER
  • Summary:

    The Access and Referral Specialist reports to a Patient Access Supervisor. Under the general supervision ensures the quality of the referral process is upheld to departmental standards. Evaluates the incoming referral for information that is accurate and appropriately reflects the patient symptom to the requested treatment. Ensures quality control of the referral process is upheld by reviewing the accuracy and timeliness of referrals through monthly standard reports. Coordinates the effective and efficient processing and scheduling of all incoming referrals adhering to established timelines and departmental procedures.

     

    Responsibilities:

    Receives and reviews all incoming referrals ensuring completeness and accuracy. Ensures all information is received including patient demographics insurance and authorizations. Communicates promptly with referring provider and/or patient regarding insurance coverage issues (e.g. non-participation status) so the patient may seek timely services elsewhere.

    Evaluates and determines triage when reviewing the referral by following established clinic referral guidelines for complete/compliant information.

    Determines if referral is in need of additional clarification evaluates the content matter to services requested and determines if the referral needs to be escalated to management for assistance or resolution.

    Returns incomplete/non-compliant referrals based on triage guidelines to referring physician office indicating the reason for return.

    Ensures quality control of the referral process is upheld by reviewing the accuracy and timeliness of referrals through Monthly standard reports.

    Provides accurate and timely communication with patients referring providers and other staff.

    Performs at benchmarked levels related to accuracy productivity quality and customer service as defined by industry standards and internal quality management.

    Coordinates and provides guidance to Outpatient Service Representative (OSR) or other staff to ensure proper documentation is made in referral record. Assists and provides support to staff when entering all referral information into the electronic health record (EHR) for any external referrals received including demographics reason for referral and insurance/authorization information. Scans referrals received by fax and/or on paper into the appropriate section of the referral record.

    Documents any communication with referring providers patients and/or Clinic (MD RN etc.) in the EHR.

    Responds to incoming telephone calls regarding pending referrals including timely response to voicemail messages.

    Coordinates and provides support when scheduling all referral appointments established by practice protocols and specifically those that require prior authorization. Maintains current knowledge of insurer referral/authorization requirements have a working understanding of the patient population and demonstrate cultural awareness and sensitivity.

    Schedules appointments according to triage guidelines. Ensures all demographics information is updated insurance verified and authorizations obtained. Notifies patients of appointment explains and educates patient to a level of understanding for the preparation needed for the upcoming appointment. Communicates with referring providers and ensures documentation of that communication in the EHR.

    Documents any and all communication with patients in the EHR. Communicates with referring providers when patients decline appointments and/or do not keep their appointments. Refers patients to the Patient Financial Advocate when necessary.

    Acts as a liaison/resource with patients referring providers community providers and practice team members regarding referral issues utilizing the highest level of customer service.

    Consistently monitors clinic schedules to ensure maximized scheduling and fills any available/open timeslot including those appointments cancelled and/or rescheduled.

    Notifies Provider and/or Supervisor if unable to schedule referral or if there are access issues.

    Monitors Referral Work-Queues and ensures that all referrals have been processed accordingly.

    Performs other duties as assigned.

     

    Other information:

    BASIC KNOWLEDGE:
    Associate degree in health information technology or related field or the equivalent experience in an ambulatory setting.
    Formal education in medical terminology anatomy and other coding-related course.

    EXPERIENCE:
    Two years of clinical referral experience required and/or at least one year of related experience in coding/billing and medical record operations in an ambulatory care facility Health Information/Medical Record Department.
    Familiarity and understanding of the content of the medical record.
    Spanish speaking strongly preferred.
    Strong organizational skills with a proven ability to prioritize and handle frequent changes in workload and able to manage competing priorities.
    Excellent customer service and communication skills with the ability to discuss delicate matters with patients and referring providers required.
    Demonstrated knowledge and skills necessary to provide care to patients through the life span with consideration of aging processes human development stages and cultural patterns in each step of the care process.

    WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
    Work is performed in a typical medical office setting requiring extensive sitting standing and walking. Reads referrals for new patient appointments for the majority of a day. Ability to work under fast paced sometimes stressful conditions to process new patient referrals meeting productivity and accuracy metrics. Organized and able to manage competing priorities ability to use good judgment by showing resourcefulness in problem solving.

     

    Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

     

    Location: Rhode Island Hospital USA:RI:Providence

     

    Work Type: Per Diem

     

    Shift: Shift 1

     

    Union: Non-Union

  • 21 Days Ago

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Referral Specialist II (US)
  • Elevance Health
  • Island, RI FULL_TIME
  • Job Description Referral Specialist Location : Remote must live within 50 miles from a Pulse Point A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon...
  • 23 Days Ago

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Referral Specialist PD
  • Lifespan Physician Group
  • Providence, RI OTHER
  • Summary: The Referral Specialist reports to the Practice Manager. Under the general supervision coordinates the effective and efficient patient flow in regards to scheduling appointments with speciali...
  • 3 Days Ago

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HVAC Technician - East Providence, RI
  • Career and Referral
  • East Providence, RI FULL_TIME
  • At Trane TechnologiesTM and through our businesses including Trane® and Thermo King®, we create innovative climate solutions for buildings, homes, and transportation that challenge what’s possible for...
  • 3 Days Ago

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Kitchen Designer/Sales Consultant
  • RIHI The Kitchen and Bath Specialist
  • Warwick, RI FULL_TIME
  • In-Home sales: Kitchen DesignerRIHI is a full-service Kitchen and Bath Remodeling company specializing in residential remodeling. We have been family-owned and operated for 75 years. Our mantra is to ...
  • 2 Days Ago

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Sales Consultant - Home Improvement (In Home)
  • RIHI The Home Improvement Specialist
  • Warwick, RI FULL_TIME
  • Job Description Job Description RIHI The Home Improvement Specialist , one of the area's largest Specialty Home Improvement companies, seeks highly motivated in-home sales consultants to sell our Excl...
  • 3 Days Ago

Rhode Island (/ˌroʊd -/ (listen)), officially the State of Rhode Island and Providence Plantations, is a state in the New England region of the United States. It is the smallest state in area, the seventh least populous, the second most densely populated, and it has the longest official name of any state. Rhode Island is bordered by Connecticut to the west, Massachusetts to the north and east, and the Atlantic Ocean to the south via Rhode Island Sound and Block Island Sound. It also shares a small maritime border with New York. Providence is the state capital and most populous city in Rhode Is...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Referral Specialist jobs
$41,996 to $51,661

Referral Specialist in Paramus, NJ
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A referral specialist may be required to communicate via email and letter, phone, or in person.
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