Clinic - Referral Specialist - PHIL-MG GI Park Ridge RMIL

Prime Healthcare; Central Ontario; On-site; CAD 30,000 - 60,000; Full time

Job summary

An established industry player is seeking a Referral Specialist to enhance patient care by acting as a vital link between healthcare providers and insurance companies. This role involves scheduling referrals, navigating prior authorizations, and ensuring seamless communication with patients and clinics. Ideal candidates will possess strong customer service skills, a positive attitude, and a solid understanding of medical terminology. Join a dynamic team that values flexibility and offers a comprehensive benefits package tailored to individual needs. If you're ready to make a difference in the healthcare sector, this opportunity is perfect for you.

Benefits

Paid Time Off

401K Retirement Plan

Medical Coverage

Dental Coverage

Vision Coverage

Tuition Reimbursement

Qualifications

• 2 years of experience in a clinic environment preferred.
• Knowledge of medical terminology and insurance plans is essential.

Responsibilities

• Act as a liaison between insurance and healthcare providers.
• Schedule referrals and communicate with clinics and patients.
• Review clinical data for medical necessity reporting.

Skills

Medical Terminology

Customer Service Skills

Organizational Skills

Telephone Etiquette

Multi-tasking

Detail-oriented

Education

Medical Assistant Program

2 Years of Clinic Experience

Tools

Electronic Medical Systems

Job description

Overview

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Responsibilities

The following statements are intended to describe the major elements and requirements of the position and should not be taken as an all-inclusive list of responsibilities, duties, and skills required of an individual assigned to this job:

1. Acts as a liaison between insurance, healthcare providers, and the clinic to ensure required referrals have been processed correctly for medical specialty visits.
2. The Referral specialist is responsible for scheduling referrals for patients at the request of providers and/or staff.
3. Directly communicates with the clinics, referred to clinics, and patients.
4. Reviews clinical data to report medical necessity to insurance companies.
5. Performs all work in accordance with the mission, vision, and values of the practice.
6. Makes referrals to specialists for the office practices along with prior authorization and creates positive relationships between the office practices and specialists.
7. Other duties include, but are not limited to, filing/scanning patient reports, retrieving patient records for prior authorizations or medical records, and completing insurance prior authorization.
8. Demonstrates adequate knowledge of the usual terminology of the referral process and tests/surgeries along with insurance plans.
9. Demonstrates good telephone etiquette and speaks to patients and others in a polite and friendly manner.
10. Maneuvers through prior authorization with insurance companies and provides patient support by utilizing resources such as sliding fee scale, payment arrangements, etc.
11. Conveys a positive image of the organization and maintains an upbeat customer-friendly attitude for internal and external customers.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

1. 2 years of experience in a clinic work environment preferred.
2. Knowledge of medical terminology preferred.
3. Completion of medical assistant program desired; certification within 6 months of hire.
4. Knowledge of Electronic Medical Systems.
5. Excellent phone skills and customer service skills.
6. Upbeat, positive, customer-friendly attitude towards internal and external customers.
7. Knowledge of prior authorizations and insurance plans.
8. Good organizational skills.
9. Ability to act as a patient liaison to help them navigate the healthcare system.
10. Self-starter and able to multi-task.
11. Able to organize and troubleshoot scheduling and/or referral issues and have solutions.
12. Detail-oriented.
13. Able to work in a changing environment.

Prime Healthcare Illinois Medical Group offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $18.15 to $24.42. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials, and licensure.