Referral Specialist

Intermountain Healthcare Inc.; Nevada; On-site; USD 27,000 - 39,000; Full time

Benefits offered by this job

Benefits eligible

40-hour work week

Job summary

Intermountain Health in Nevada seeks a Referral Specialist to be the first contact for patients, guiding referrals through insurance requirements and authorizations. The role emphasizes accurate data entry, clear communication, and collaborative care coordination with hospitals, physicians, plans, and patients.

Responsibilities include verifying benefits, obtaining authorizations, and ensuring timely referrals, while supporting efficient patient flow and service excellence in a Monday–Friday

Qualifications

• Demonstrated experience using multiple business software applications and insurance web portals simultaneously.
• Prior experience in healthcare.
• Associate or higher level degree.
• One year of experience with referral services, referral processing, authorization/referral claims administration or a directly related field.

Responsibilities

• Identify and resolve patient, provider, and staff requests including referrals, scheduling, billing inquiries.
• Use analytical skills to anticipate and resolve patient requests and handle emergencies.
• Support productivity and quality by contributing to KPIs.
• Verify eligibility and benefits, obtain authorizations, and track referrals.
• Coordinate with hospitals, physicians, health plans, vendors, and patients to submit insurance authorizations.
• Gather information from carriers and financial counselors to determine patient financial obligations.
• Document information in the referral system with authorization data and locations.
• Follow the three-touch process: MyChart, phone, and letter.
• Forward medical records and authorization information to the provider's office.

Skills

Medical Terminology

Computer Literacy

Customer Service

Data Entry

Problem Solving

Communication

Detail Oriented

Critical Thinking

Analytical Thinking

Interpersonal skills

Education

Associate or higher degree

Tools

Electronic Medical Records (EMR)

Insurance Web Portals

Job description

Job Overview

The Referral Specialist is the first connection between Intermountain and patients and is responsible to focus on establishing collaborative relationships with patients and fellow caregivers (employees) to deliver the highest level of customer/patient satisfaction. Referral Specialists are responsible for fostering relationships with patients, parents and guardians regarding the patient's care to include ensuring compliance with managed care, commercial insurance, and public insurance requirements, submitting and tracking referrals, and providing efficient patient flow and service excellence.

Posting Specifics

Benefits Eligible: Yes

Shift Details: Monday - Friday 8:30am to 5:00pm

Essential Functions

• Effectively identifies and resolves patient, provider, and staff requests which may include; referral processing, scheduling/registration, business/billing/payor inquiries, and medical requests.
• Uses analytical skills and technical resources to anticipate and resolve patient requests, demonstrates critical thinking and problem solving during challenging patient interactions and situations with ability to recognize and follow appropriate procedures for medical and non-medical emergencies.
• Contributes to and supports enterprise productivity and quality measures/initiatives by participating, planning, communicating, and encouraging team and individual contributions toward Intermountain Health Key Performance Indicators.
• Verifies eligibility and benefits; obtains authorizations, and tracks referrals to ensure compliance with guidelines.
• Acts as a liaison between hospitals, physicians, health plans, vendors and patients or other referral sources to submit for insurance authorization for procedures, specialist visits for patients referred by an Intermountain primary care provider.
• Gathers pertinent information from insurance carriers, financial counselors and other ancillary staff to make certain of the patients’ financial obligations for services provided.
• Documents appropriate and complete information within the referral shell to include authorization information, location patient referred to close the loop, coordinating with teams, providers, staff, insurance companies, patients, and other clinics.
• Follows the three-touch process, reach out to patient via MyChart, phone call and letter.
• Forwards all pertinent medical records and authorization information referred to the provider’s office.

Skills

• Medical Terminology
• Computer Literacy
• Customer Service
• Electronic Medical Records (EMR)
• Data Entry
• Problem Solving
• Communication (Written/Oral)
• Detail Oriented
• Critical Thinking
• Analytical Thinking
• Interpersonal skills

Minimum Requirements

• Demonstrated experience using multiple business software applications and insurance web portals simultaneously
• Prior experience in healthcare

Preferred Requirements

• Associate or higher level degree
• One year of experience with referral services, referral processing, authorization/referral claims administration or a directly related field

Physical Requirements

Ongoing need for employee to see and read information, labels, monitors, identify equipment and supplies, and be able to assess customer needs. Frequent interactions with customers that require employee to communicate as well as understand spoken information, alarms, needs, and issues quickly and accurately. Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer, phone, and cable set-up and use. Expected to lift and utilize full range of movement to transport, pull, and push equipment. Will also work on hands and knees and bend to set-up, troubleshoot, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items. For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location and Hours

Location: Nevada Central Office Work City: Las Vegas Work State: Nevada

Scheduled Weekly Hours: 40

Salary

The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $19.41 - $28.14

Benefits

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package.

Compliance and Policies

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

Equal Opportunity

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Data Privacy

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment.

Company Overview

Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.

PEAK Program

The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor.

The PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more.

Legal Notice

All positions subject to close without notice.

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