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)
Job Summary: The Referral Intake Specialist-ORC reviews and analyzes patient referrals for preauthorization, concurrent review and case management for outpatient and inpatient service areas. Obtains benefits and eligibility as well as authorizations or pre-certifications as required, schedules patient appointments as authorized. Educates and informs staff, physicians and the community about services offered. Maintains a working relationship with internal and external referral sources by traveling and completing a daily distribution/pick up run to providers. Allows Rehabilitation Services to stay in consistent communication with the referring specialties and providing necessary updates. This position serves all areas of Rehabilitation Services. Performs other duties as needed.
Education and Experience: High School Diploma or GED required. Minimum one year of call center experience in a customer service, sales environment, or clinical experience required. Minimum three years of experience in healthcare customer service call center preferred.
Knowledge and Skills: Able to demonstrate excellent customer service and good communication skills, with emphasis on telephone etiquette. Able to keyboard 30 wpm. Able to read; write legibly; speak in English (and Spanish preferred) with professional quality; use computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook). Operate/troubleshoot basic office and patient care equipment required for the position; perform required patient care activities related to the position. Able to relate and communicate positively, effectively, and professionally with others; work calmly and respond courteously when under pressure; collaborate and accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.
Licensures and Certifications: None.
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