Advertised Title Clinical Referral Specialist, CMG Referrals and Diagnostics

Covenant Health; Idaho; Hybrid; USD 40,000 - 60,000; Full time

Job summary

Covenant Medical Group in Idaho is seeking a Clinical Referral Specialist to manage scheduling for specialty facilities, handle pre-certifications, and register new patient charts. You will verify insurance eligibility and coordinate with patients, providers, and staff to ensure timely care.

The role emphasizes accuracy in referrals, documentation, and compliance with insurance requirements, with responsibilities spanning internal and external coordination and continuous process improvement.

Qualifications

• High school diploma or GED required or similar experience.
• Bachelor’s degree in a related field preferred.
• 1–2 years of Referrals and Diagnostics experience with pre-certification knowledge.
• Medical terminology knowledge is required.

Responsibilities

• Schedule inpatient/outpatient tests, procedures, and appointments as directed by provider.
• Complete referrals and pre-certifications accurately (authorizations).
• Obtain authorizations from patient’s insurance and update the EHR.
• Know requirements from insurance plans, hospitals, and ambulatory facilities.
• Maintain accurate logs of testing, referrals, and appointments with follow-ups.

Skills

Referral coordination

Scheduling

Pre-certifications

Medical terminology

Customer service

Education

High school diploma or GED

Bachelor’s degree preferred

Tools

Electronic Health Records (EHR)

Job description

Overview

Clinical Referral Specialist, CMG Referrals and Diagnostics

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Medical Group Overview:

Covenant Medical Groupis the employed and managed medical practice organization of Covenant Health, providing comprehensive care across East Tennessee. With more than 300 physicians and advanced practice providers in 20 communities, our team deliversexpertiseacross a broad spectrum of specialtiesfrom primary careand walk-in clinics topreventive medicineandadvanced surgical andsubspecialty services.We are committed to offering coordinated, patient-centered care that spans the continuum of health needs, ensuring access to exceptional providers close to home.

Position Summary:

The Referral and Precertification Specialists manages scheduling for specialty facilities and procedures, creates and registers new patient charts, verifies addresses, and submits insurance eligibility. They prioritize orders, obtain pre-certifications and follow up on referrals and authorizations to ensure timely patient care. The specialist collaborates with patients, providers, and nursing staff to ensure a team-based approach to patient care.

Responsibilities

• Schedule inpatient/outpatient tests, procedures, and appointments as directed by provider. Documents each event in detail in the medical record.
• Accurately completes all forms required for referrals and pre-certifications (authorizations).
• Authorizations are obtained from the patient’s insurance and added to the electronic health record.
• Knowledge of requirements and guidelines as mandated by insurance plans, hospitals, outpatient facilities, and ambulatory practices.
• Maintains accurate testing, referral, and appointment logs with follow-up verification in the Referral/Diagnostic tracking database.
• Knowledge of ICD-10, CPT Coding, and basic computer skills.
• Coordinates date, time, and location of procedure/appointment with the patient, facility, and provider.
• Communicates appointments as well as special instructions regarding scheduled procedure/appointment with the patient.
• For Internal Referrals, the patient will be notified of an appointment by the provider’s practice receiving the referral.
• For External Referrals, the office staff will verify whether the practice receiving the referral will contact the patient regarding appointment information. If they will not then CMG staff will communicate appointment information to the patient by phone, text, patient portal, and/or USPS mail.
• Report any problems obtaining referrals, pre-certifications or appointments as ordered by the provider.
• Collaborate with the patient, physician, and other care team members as part of a team-based approach to overall patient care.
• Assists in the orientation and education of Centralized Referral team.
• Assists in the development and maintenance of departmental training manuals and workflow documents.
• Provides support and assistance for employees.
• Professionally consults with patients, providers, and hospital staff members regarding the scheduling and pre-registration of appointments.
• Attends meetings as required and participates on committees as directed.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education:

None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a Bachelor’s degree in a directly related field from an accredited college or university.

Minimum Experience:

One (1) to two (2) years’ experience in Referrals and Diagnostics with pre-certification experience. Medical terminology knowledge a must.

Licensure Requirement:

None