Referral Specialist

CommonSpirit Health; Ringgold (GA); Vor Ort; USD 42.000 - 54.000; Vollzeit

Zusammenfassung

CommonSpirit Medical Group in Ringgold, GA is seeking a Referral Specialist to orchestrate patient access by managing referrals and authorizations for specialty care. You will obtain clearances for visits, issue referrals for ancillary services, and secure approvals for medications and related services.

Strong attention to detail and clear communication are essential to ensure smooth patient flow. You will verify orders, answer billing questions, coordinate appointments, and ensure accurate

Qualifikationen

• High school diploma or GED with healthcare experience.
• Experience in a healthcare environment and referral processes preferred.
• Experience with AEHR and PPMS systems is a plus.

Aufgaben

• Gather, verify, and process referrals, authorizations, and pre-certifications with physicians, patients, and payers.
• Communicate plan details and billing/insurance questions to patients clearly.
• Set up appointments, coordinate clinic visits, and arrange transport or interpreters as needed.
• Provide patients with referral information including date, time, location, and contact details.
• Coordinate sharing of information between clinic and patient insurance for valid referrals.
• Enter and annotate testing information and referrals, perform e-referrals as applicable, and document communications in PPMS/AEHR.

Kenntnisse

Attention to detail

Organizational skills

Clear communication

Ausbildung

High School Diploma

GED

Tools

AEHR

PPMS

Jobbeschreibung

Job Summary and Responsibilities

As our Referral Specialist at CommonSpirit Medical Group - Family Medicine - Ringgold , you will orchestrate patient access to specialized care by expertly managing all referral and authorization processes.

Every day, you will proactively obtain clearances for specialty visits, issue referrals for ancillary services (consults, imaging, labs), and secure approvals for medications, DME, home health, and other vital services.

To be successful in this role, you will demonstrate meticulous attention to detail, strong organizational skills, and clear communication to ensure seamless and efficient service delivery for our patients.

• Gather, verify, and process orders for test, referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
• Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.
• Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
• Communicates or gives written material to patients with referral information such as date, time, and location, as well as contact information to ensure patient has resources to review if needed.
• Coordinate flow of information between medical clinic and patients insurance for referral authorization to secure a valid referral for clinic patient.
• Enter and annotate testing information and referrals, does e-referral for applicable practices for meaningful use and follows-up to make sure e-referral and or faxed referrals are received, documents communications and action into PPMS and AEHR, as appropriate.

Job Requirements

Required

• High School Graduate General Studies and 2 years of progressively responsible related experience in a healthcare environment, upon hire or
• High School GED General Studies and 2 years of progressively responsible related experience in a healthcare environment, upon hire and
• None, upon hire

Preferred

• 2 years of progressively responsible related experience in a healthcare office environment specializing in the referral process and
• Experience in AEHR and PPMS system

Where You'll Work

CommonSpirit Medical Group (Mountain Management Services) is a leading provider of comprehensive office management services and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI, CMS, Healthgrades, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.