Referral Specialist

Northern Light Health; Presque Isle (ME); Hybrid; USD 25,000 - 30,000; Full time

Job summary

Northern Light Health Home Office in Presque Isle, ME, is hiring a Referral Specialist for a hybrid, full-time role. The position supports diagnostic referrals, prior authorizations, and care coordination with a scheduled 8:00 AM to 4:30 PM shift.

The ideal candidate has an associate degree in a related field and experience in medical offices or health systems, with strong communication and organizational skills to ensure timely patient care.

Qualifications

• Commitment to accuracy and attention to detail in processing referrals and authorizations.
• Experience supporting patients, providers, and payers in a fast-paced environment.
• Familiarity with insurance processes and CPT coding is a plus.

Responsibilities

• Manage outgoing and incoming referrals and ensure timely processing.
• Obtain authorizations for procedures and diagnostics as assigned.
• Communicate with patients, providers, insurers, and referrers to coordinate care.
• Add new patients to the EMR when needed and assist with scheduling as assigned.
• Monitor prior authorizations and referrals for assigned departments.
• Maintain CPT knowledge and referral tracking documentation.
• Assist with claim denials and coding to support authorization.
• Suggest process improvements aligned with department goals.
• Ensure compliance with Medicare and third-party payers.

Skills

Adaptability

Communication

Judgment

Integrity

Respect

Accountability

Compassion

Education

Associate's Degree in business management, healthcare, administration, medical coding, or related field

Tools

EMR system

Job description

Northern Light Health Home Office |US:ME:Presque Isle or Hybrid | Administrative Support | Full Time

Salary range- 18.50-22.10 USD

Description

The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits.

Northern Light Health

Position is located:Northern Light A.R. Gould Hospital

Work Type:Full Time

Work Schedule:8:00 AM to 4:30 PM

Salary Range : $ 18.50 - $22.10

Exempt: No

Summary:

Referral specialists are responsible for assuring that patients needing diagnostic tests and specialty services are referred to the appropriate department/office efficiently to assure services needed are received timely. They assist with insurance prior authorizations. The role of the referral specialist is critical to assure that every patient receives the definitive care that they need. A major role of the Referral Specialist is to communicate progress of referrals to patients, families, and referring providers. Key characteristics to be successful include expert communication, knowledge of insurances and health systems, teamwork, collaboration, organizational skills, and detail orientation. Multitasking ability is essential as Referral Specialists often are working on multiple cases at a time. Fast paced setting requires independent thinking, ability and willingness to be flexible and adaptable to changes. Re-prioritization of tasks occurs frequently.

Responsibilities:

• Manages outgoing referrals and incoming referrals as assigned.
• Obtains authorizations for procedures and diagnostics as assigned.
• Communicates with patients, providers, office staff, insurers and referrers. Works collaboratively with clinical staff, providers, surgical schedulers, ancillary departments, and insurance carriers to complete work.
• Adds new patients to EMR when needed, including assisting with scheduling as assigned.
• Manages and monitors prior authorizations/out-going referrals for the assigned departments(s) following Policy and Procedures.
• Maintains working knowledge of inpatient vs. outpatient procedures and CPT codes.
• Maintains referral tracking documentation to determine that referral is complete.
• Maintains current knowledge of various insurance processes necessary to obtain prior authorization; follows Prior Authorization Policy.
• Assists with claim denials/research as assigned.
• Assists with coding to assure appropriate authorization of procedures.
• Makes recommendations for change to improve processes in accordance with mission statement and established goals.
• Ensures compliance with Medicare and third-party payers procedures.
• Maintain safety standards at all times and report safety issues immediately.
• Maintains mandatory education compliance.

Other Information:

Competencies and Skills

• Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
• Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
• Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Education

• Required Associate's DegreeAssociate degree in business management, healthcare, administration, medical coding, or related field or 2 years’ experience in a medical office or related setting is required.

Required Experience

• 0 year/years of Relevant Work Experience

Working Conditions

• Prolonged periods of sitting.
• Lifting, moving and loading less than 20 pounds.

As an integrated health delivery system serving Maine, Northern Light Health is raising the bar with no-nonsense solutions that are leading the way to a healthier future for our state. Our care team—I hospitals, primary and specialty care practices, long-term and home healthcare, behavioral healthcare, and ground and air medical transport and emergency care—are committed to making healthcare work for you: our patients, communities, and employees.

Brewer, Maine, Corporate Office, Cianchette, Foundation, Finance, Human Resources, Legal Services

Equal Opportunity Employment

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sex, sexual orientation, gender identity, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.