Clinic - Referral Specialist

Prime Healthcare; Lewiston (ME); Sur place; USD 29 000 - 36 000; Plein temps

Résumé du poste

Central Maine Medical Center in Lewiston, ME is seeking a Referral Specialist in Neurology for a full-time day shift. This role coordinates referrals, schedules visits, and communicates with clinics, patients, and insurers to ensure medical necessity is documented.

You will support prior authorizations, manage records, and maintain a courteous, patient-centered approach while navigating insurance plans. Pay ranges from $20.71 to $26.01 per hour, with benefits and growth opportunities.

Qualifications

• 2 years of clinic work experience preferred.
• Knowledge of medical terminology preferred.
• Completion of medical assistant program desirable; certified within 6 months of hire.
• Knowledge of Electronic Medical Systems.
• Excellent phone skills and customer service skills.
• Upbeat, positive, customer-friendly attitude towards internal and external customers.
• Knowledge of prior authorizations and insurance plans.
• Good organization skills.
• Be able to act as a patient liaison to help navigate the healthcare system.
• Self-starter with ability to multi-task.
• Organize and troubleshoot scheduling/referral issues with solutions.
• Detail-oriented.
• Able to work in a changing environment.

Responsabilités

• Liaise between insurance, providers, and the clinic to ensure referrals are processed correctly.
• Schedule referrals for patients at the request of providers and staff.
• Directly communicate with clinics, referred clinics, and patients.
• Review clinical data to report medical necessity to insurance companies.
• Handle prior authorizations and maintain relationships between offices and specialists.
• File/scan patient reports and retrieve records for prior authorizations or medical records.
• Demonstrate knowledge of referral terminology and insurance plans.

Connaissances

Phone skills

Patient liaison

Multitasking

Formation

2 years clinic work experience

Medical assistant program

Outils

Electronic Medical Records (EMR) systems

Description du poste

Overview

Title: Referral Specialist Department: Neurology

Full Time, Day shift Schedule: 8am-4:30pm

Pay: $20.71 to $26.01

Location: Central Maine Medical Center

Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service.

CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities.

As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing and medical imaging school. The private, not-for-profit institution is accredited by the New England Commission of Higher Education and plays an important role in training the next generation of healthcare professionals.

To learn more, visit www.cmhc.org.

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. Acts as a liaison between insurance, healthcare providers, and the clinic to ensure required referrals have been processed correctly for medical specialty visits. The Referral specialist is responsible for scheduling referrals for patients at the request of providers and/or staff. Directly communicates with the clinics, referred to clinics, and patients. Reviews clinical data to report medical necessity to insurance companies. Performs all work with accord to the mission, vision, and values of the practice. The referral specialist makes referrals to specialist for the office practices along with prior auth and creates positive relationships between the office practices and specialists. Other duties include, but are not limited to, filing/scanning patient reports, retrieving patient records for prior authorizations or medical records and completes insurance prior authorization. The Referral specialist should demonstrate adequate knowledge of the usual terminology of Referral process and tests/surgeries along with insurance plans. This person should demonstrate good telephone etiquette and be able to speak to patients and others in a polite and friendly manner. Be able to maneuvers through prior authorization with insurance companies and provide patient support by utilizing resources such as sliding fee scale, payment arrangements etc. Conveys a positive image of the organization and maintains a upbeat customer friendly attitude for internal and external Customers.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

1. 2 year experience in a clinic work environment preferred.

2. Knowledge of medical terminology preferred.

3. Completion of medical assistant program desired Certified 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 organization skills.

9. Be able to act as a patient liaison to help them through navigate the healthcare system.

10. Be a self-starter and able to multi-task.

11. Able to organize and trouble shoot scheduling and or referral issues and have solutions.

12. Detailed orientated.

13. Be able to work in a changing environment.

Pay Transparency

Central Maine Medical Center offers competitive compensation and a reasonable compensation estimate for this role is $20.71 to $26.01. 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.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

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. 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