Referral Specialist

Banner Health; Arizona; Hybrid; USD 27,000 - 40,000; Full time

Job summary

Banner Health is seeking a dedicated Referral Specialist to support Banner-ordered referrals remotely. You will leverage Cerner's referral management tools and navigate insurance requirements and authorization processes to ensure timely patient care.

Responsibilities include coordinating referrals, ensuring payor authorization readiness, and tracking referrals to close care gaps, while providing clear information to patients and providers in a fast-paced healthcare environment.

Qualifications

• Experience interacting with patients in medical/insurance/healthcare setting.
• Knowledge of HIPAA regulations and privacy requirements.
• Strong communication and problem-solving skills.
• Ability to manage multiple priorities and use common office software.
• Understanding of insurance authorizations and payor requirements.

Responsibilities

• Coordinate referral orders for continued treatment within primary care practices.
• Provide clinical information for payor authorization before services.
• Track referrals and follow up to close care gaps.
• Educate patients and staff about referral processes and resources.
• Collaborate with external referral sources and networks.

Skills

Customer service

HIPAA knowledge

Verbal and written communication

Task prioritization

Office software

Education

High School Diploma or GED

Job description

Department Name:

CEC-Clinical Integration

Work Shift:

Day

Job Category:

Administrative Services

Health care is constantly changing, and at Banner Health, we are at the front of that change. We are leading health care to make the experience the best it can be. We want to change the lives of those in our care & the people who choose to take on this challenge. If changing health care for the better sounds like something you want to be part of, we want to hear from you.

Banner is seeking a dedicated and detail-oriented Referral Specialist. This role focuses on supporting Banner-ordered referrals while leveraging extensive knowledge of Cerner's referral management tool and a strong understanding of insurance requirements and authorization processes.

Duties: You will support Banner ordered referrals.

Location: REMOTE

Hours: Monday – Friday 8am-5pm

Training: Training and ongoing support will be provided by peers in a similar position

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.

POSITION SUMMARY

This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a primary care practice. This position provides all pertinent clinical information needed for the payor authorization and the facility or specialist prior to the services being rendered. The position is responsible for tracking and managing all referrals with the intention and outcome to close any patient care gaps, along with providing documentation to promote team awareness.

CORE FUNCTIONS

1. Schedules appointments for specialty physician services and diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements

2. Acts as a liaison between patients, providers and staff members for patients’ referral and follow up needs. Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed.

3. Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities

4. Tracks and manages all referrals by monitoring outstanding referrals at 30/60/90 day intervals and following up with patients if appointments are not kept

5. Applies knowledge of medical terminology and maintains up to date knowledge of insurance environment. Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources

6. Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources

7. This position has frequent communications with patients, physicians, staff, and third party payers. The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with moderate supervision

MINIMUM QUALIFICATIONS

High school diploma/GED or equivalent working knowledge.

Possesses 1 year of direct patient interaction/experience in a medical, insurance, or healthcare related industry.

Knowledge of HIPAA regulations. Strong customer service focus and willingness to problem solve. Effective verbal and written communication skills and the ability to manage competing priorities. Must be proficient with commonly used office software.

PREFERRED QUALIFICATIONS

Previous knowledge of managed care concepts. Working knowledge of medical terminology and ICD-9 and CPT codes.

Additional related education and/or experience preferred.

Estimated Pay Range:

$19.45 - $29.17 / hour

Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.

This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.

EEO Statement:

EEO/Disabled/Veterans (https://www.bannerhealth.com/careers/eeo)

Our organization supports a drug-free work environment.

Privacy Policy:

Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)

EOE/Female/Minority/Disability/Veterans

Banner Health supports a drug-free work environment.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability