Referral Specialist

Optum; Acton (MA); On-site; USD 22,041 - 39,950; Full time

Job summary

Acton Medical Associates, part of the Optum family, is seeking a Referral Specialist to handle insurance referral intake and processing. The role involves speaking with patients by phone, confirming demographics and insurance, scheduling appointments, and gathering information for referrals.

This full-time, on-site position supports AMA-PC operations. The ideal candidate has a high school diploma, BCLS, EMR experience, and strong communication while maintaining confidentiality; benefits include

Qualifications

• High School graduate or GED required.
• BCLS certification.
• Experience with EMR, scheduling, and word processing software preferred.
• Friendly and courteous personality required.
• Excellent communication skills and ability to maintain confidentiality.

Responsibilities

• Works full time, on site, to support AMA-PC operations.
• Maintain professionalism and provide excellent patient service.
• Schedule appointments following provider protocols and verify eligibility for Mass Health.
• Handle calls, retrieve messages, and follow up as needed.
• Enter referral requests in EMR from calls, portal, or faxes.
• Obtain PCP approvals for insurances requiring physician signature.
• Confirm specialist participation with insurance websites.
• Process referrals per 4–5 business day protocol and HIPAA/PHI rules.

Skills

High School diploma or GED

BCLS

EMR scheduling software

Excellent communication skills

Confidentiality

Tools

Allscripts EMR

Word processing software

Scheduling software

Job description

Explore opportunities with Acton Medical Associates, part of the Optum family of businesses. Acton Medical Associates provides exceptional primary care for adult and pediatric patients. Our team of dedicated physicians and skilled professionals deliver personalized, top-notch support to every patient. With a focus on integrity and trust, we foster a care experience that brings confidence to patients and their families. Through our collaborative environment and commitment to clinical excellence, you'll have the opportunity to make a meaningful impact while growing your career. Join a team at the forefront of value-based care and discover the meaning behind Caring. Connecting. Growing together.

The Referral Specialist is responsible for obtaining insurance referral intake and processing the referral requests. In this role, the Referral Specialist speaks to patients on the phone, confirms patient demographic and insurance information makes appointments and obtains the proper information for referral requests. A key responsibility of the Call Center Representative is to ensure our patients received best possible customer service. This position requires excellent communication, computer and phone skills and the ability to multi-task.

Primary Responsibilities

• Works full time, on site, to support the operations of the department and AMA-PC
• Maintain a high level of professionalism and provide excellent patient servicing
• Schedule future appointments following the individual provider's protocol. Verify eligibility on all Mass Health members before scheduling the appointment
• Follow phone queue daily assignment. Retrieve night and referral voicemail when assigned and follow-up on the messages
• With the managers assistance, learns to problem solve and assist with the more complex referral requests
• Follow-up with specialist offices to obtain pertinent information that is essential for the referral processing workflow
• Enters referral requests in the Allscripts EMR from patient calls, Follow My Health or faxes received from physician offices
• Obtain PCP approvals for insurances that require a physician signature and reviewer's 2nd signature
• Confirm specialist participation with insurance via the individual health plans website
• Process referrals utilizing the correct web sites, and follow the 4-5 business day referral processing protocol
• Must observe HIPAA & PHI (Protected Health Information) Regulations at all times
• Other duties as assigned by Call Center Manager or Director

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• High School graduate or GED equivalent
• BCLS
• Knowledge of EMR, scheduling and word processing software
• Friendly and courteous personality

Excellent communication skills and the ability to maintain confidentiality

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 to $29.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.