Referral & Appointment Navigator for Patient Access

CommonSpirit Health; Washington (District of Columbia); On-site; USD 52,000 - 72,000; Full time

Job summary

Virginia Mason Franciscan Health is seeking a Referral Specialist to orchestrate patient access by managing referral and authorization processes. You will obtain clearances for specialty visits, issue referrals for ancillary services, and secure approvals for medications and DME.

The role requires meticulous attention to detail, strong organizational and communication skills to ensure seamless service delivery for our patients.

Qualifications

• Successful completion of an accredited medical terminology course(s) or equivalent on the job training, upon hire
• One year of progressively responsible work experience in a related role
• None, upon hire

Responsibilities

• Process referral orders and/or pre-authorizations.
• Ensure insurance eligibility checks are conducted before the patient is seen by escalating to the Insurance Verifier or by direct eligibility checks.
• Complete referrals and/or pre-authorizations for diagnostic testing, therapy, surgeries, procedures and specialty care.
• Provide information to patients regarding their health care plan and communicate plan policies.
• Answer billing and insurance questions and obtain a cost estimate when requested.
• Notify physician and patient if a referral is denied or needs additional information.
• Update the patient’s medical record in the EMR.
• Coordinate appointments and ancillary services according to authorized referrals.

Skills

Attention to detail

Strong organizational skills

Clear communication

Customer service

Education

Medical terminology course

Tools

Electronic Medical Record (EMR) system

Insurance verification tools

Job description

Virginia Mason Franciscan Health is seeking a Referral Specialist to orchestrate patient access by managing referral and authorization processes. You will obtain clearances for specialty visits, issue referrals for ancillary services, and secure approvals for medications and DME.

The role requires meticulous attention to detail, strong organizational and communication skills to ensure seamless service delivery for our patients.