Job Detail: Referral Specialist

 
GENERAL DESCRIPTION OF POSITION:

Reports directly to the Director of Marketing, while receiving assignments from the clinical staff. Able to retrieve preauthorization and referral information accurately and timely to ensure reimbursement for services rendered. Enters patient information into computer system. Verifies insurance coverage. Liaison for Southside Providers and other healthcare delivery and payment systems.

DETAILED DESCRIPTION OF POSITION:

1.  Maintains log of all preauthorization and referral activity requested.
2.  Communicates with Southside Providers to collect clinical information needed for the referral and preauthorization process.
3.  Communicates with preauthorizing authorities to secure preauthorization numbers.
4.  Communicates with internal providers and satellites to secure appointments and referral numbers.
5.  Verifies insurance coverage to ensure appropriate reimbursement and need for preauthorization and referral for HMO insurance coverage.
6.  Able to make appointments for patients and referrals to other units of service.
7.  Assists in daily collection and completion of referrals.
8.  Re-evaluates patients’ demographic information and updates computer system accordingly.
9. Processes patient referrals received from clinical areas in a timely manner.
10.  Maintains log of all Preauthorization and Referral Activity by entering information into data base monthly
11.  Communicate within companies to secure preauthorization numbers.
12.  Compiles referral information monthly for reporting all internal tracking.
13.  Verifies insurance coverage to ensure appropriate scheduling of appointments with appropriate specialists.
14.  Completes referrals for other facilities when patients have been auto assigned to SMC by Medicaid with physician authorization.
15.  Trains other employees regarding referrals and insurance verifications.
16.  Performs other duties as assigned.
17.  Work in a clinical setting for stat referrals and authorization and obtain pre-certifications for surgeries.
18.  Must be a part of the utilization management committee.
19.  Patient notification of any appointment by mail or phone.

KNOWLEDGE, SKILLS AND ABILITIES:

1.  Ability to work on multiple complex tasks simultaneously.
2.  Well skilled in prioritizing.
3.  Must have moderate level of Medical Terminology knowledge.
4.  Good communication skills.
5.  Must have excellent interviewer skills.
6.  Must be able to generate referrals and prior authorization via web portal and internet.

MINIMUM QUALIFICATIONS:
Must have previous experience in healthcare. Two years of college credits. College graduate preferred with a good understanding of medical terminology. Must have patient with persistence. Must have knowledge of Microsoft Word.

TYPICAL PHYSICAL DEMANDS:
Requires ability to be on the telephone for long periods of time. Requires sitting for long periods of time. Requires frequent walking to different clinics. The work will be performed in an office environment/clinical setting. Some bending and stretching requires. Manual dexterity required for use of calculator and/or computer keyboard.

TYPICAL WORKING CONDITIONS:
Work is performed in an office environment/clinical setting. Involves frequent contact with medical and Administrative Staff. Liaison for Southside and external healthcare organizations.

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