Referral Specialist

Physicians' Primary Care of Southwest Florida; Fort Myers (FL); On-site; USD 32,000 - 48,000; Full time

Benefits offered by this job

Health, dental, vision, and life insur

401(k) with company match

Paid Time Off (PTO)

Paid holidays

Employee Assistance Program (EAP)

Uniform allowance

Employee appreciation week and events

Job summary

Physicians' Primary Care of SWFL in Fort Myers is seeking a Referral Specialist to manage outgoing referrals, verify in-network destinations, and document referral activity in the EMR. The role includes obtaining authorizations for specialist visits and ensuring timely communication with patients and offices.

The ideal candidate has a high school diploma, at least one year in a medical office, and strong written and verbal communication with attention to accuracy in processing referrals and

Qualifications

• High school graduation or GED.
• 1 year of work experience in a medical office setting preferred.
• Knowledge of medical terminology is desirable.
• Word processing and computer experience.

Responsibilities

• Provide excellent customer service to internal and external customers.
• Receive referral requests and communicate details for physician review.
• Ensure referrals are ordered accurately in the EMR before processing.
• Verify appropriate specialist destination and ensure referrals are directed to in-network providers.
• Fax referrals and all pertinent records within 72 business hours.
• Obtain authorization for specialist visits via payer portals.
• Notify patients of the referred specialist and provide the office contact number.
• Answer calls and respond to voicemail about referral status and documentation needs.
• Maintain accurate referral documentation in the patient hub.
• Coordinate with nurses/medical assistants for referral details and physician review.

Skills

Office procedures

Grammar and spelling

Computer skills

Phone etiquette

Clear communication

Documentation

File management

Education

High school diploma or GED

Job description

Job Title: Referral Specialist

General Summary Of Duties: The Referral Specialist is responsible for processing outgoing patient referrals, including entering referral orders (with physician approval), verifying in-network referral destinations, faxing referrals with pertinent medical documentation, and documenting referral activity in the patient's electronic medical record. The Referral Specialist is also responsible for obtaining authorizations for specialist office visits, as requested, via applicable payer portals.

Supervision Received: Reports to Site Supervisor

Supervision Exercised: None.

Typical Physical Demands: Requires prolonged sitting, some bending, stooping, stretching, and walking short distances to retrieve print jobs, fax confirmations, or to fax records as needed manually. Requires eye-hand coordination and manual dexterity sufficient to operate a computer, keyboard, telephone, and multifunction office equipment (scanner, copier, and fax). Requires a normal range of hearing and eyesight to record, prepare, and communicate appropriate information.

Typical Working Conditions: Standard medical office working conditions.

Examples of Duties:

• Provide excellent customer service (friendly, courteous, and helpful) to both our internal and external customers
• Receive referral requests from specialist offices and communicate diagnosis and referral details to the nurse/medical assistant for physician review and referral ordering.
• Ensure referrals are ordered accurately in the EMR system before processing; review diagnosis and specialty to ensure they are a suitable match. The physician or nurse must order Family Practice referrals, while Pediatric Referral Specialists may enter referral orders with physician approval.
• Verify appropriate specialist destination and ensure referrals are directed to in-network providers when applicable.
• Fax referrals and all pertinent supporting medical records, including clinical notes, lab results, and diagnostic imaging, to the appropriate specialist office within 72 business hours.
• Obtain authorization for specialist office visits upon request by utilizing applicable insurance provider portals (i.e., Availity, UHC, Leading Reach, etc.).
• Notify patients of the specialist/provider they have been referred to for STAT referrals, and provide the specialist's office phone number so the patient may schedule their appointment.
• Answer incoming calls and review voicemail messages throughout the day to respond to patients and specialist offices regarding referral status, authorization requests, and related documentation needs.
• Maintain accurate and timely referral documentation, including recording appointment dates in the Outgoing Referral section of the patient hub, and ensuring all referral and authorization activity is completed efficiently.
• Communicate with nurses/medical assistants via internal messaging to request additional referral details and provide information for review with the physician for approval.

Knowledge, Skills, and Abilities:

Knowledge of business office procedures. Knowledge of grammar, spelling, and punctuation to type patient information. Skill in operating a computer and a photocopy machine. Skill in answering the telephone in a pleasant and helpful manner. Ability to speak clearly and concisely. Ability to read, understand, and follow oral and written instructions. Ability to sort and file materials correctly by alphabetical or numeric systems. Ability to establish and maintain effective working relationships with patients, employees, and the public.

Education:

High school graduation or GED.

Experience:

One year of work experience, preferably in a medical office setting. Knowledge of medical terminology is desirable. Word processing and computer experience.

Certificate/License:

None.

Alternative To Minimum Qualifications:

Additional appropriate education may be substituted for one year of work experience.

What PPC Offers:

• 30 years growing with and supporting our communities
• Award-winning physicians
• Ability to grow within the organization
• Health, dental, vision, and life insurances
• 401(k) with company match
• Paid Time Off (PTO)
• Paid holidays
• Employee Assistance Program (EAP)
• Uniform allowance
• Employee appreciation week and events

Physicians Primary Care of SWFL participates in E-Verify. Go to https://www.ppcswfl.com/wp-content/uploads/2023/06/E-Verify_Participation_Poster_Eng_Es-06.22.23.pdf for more information.