Referral Specialist - Clarkston Medical Group

Mclaren-Health-Care; Clarkston (MI); On-site; USD 40,000 - 65,000; Full time

Job summary

McLaren Health Care, headquartered in Grand Blanc, Michigan, seeks a Referral Specialist for Clarkston Medical Group to manage referral operations and standardize workflows across the organization.

You will verify demographics and insurance data, obtain prior authorizations when needed, and ensure appropriate clinical information is sent to referred specialists, leveraging EMR functionality and collaborating with care teams.

Qualifications

• High School Diploma or GED required.
• 2+ years' experience handling referrals in a licensed medical facility.
• Exceptional organizational skills and attention to detail.
• Proficient with medical terminology and MS Office.
• Experience with ICD-10-CM coding is preferred.

Responsibilities

• Ensure current and standardized referral policies and workflows.
• Prioritize referrals by urgency and address them promptly.
• Train referral personnel and coordinate with other departments.

Skills

Interpersonal skills

Organizational skills

Attention to detail

Education

High School Diploma or GED

Tools

MS Office

EMR systems

Job description

McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan's largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.

Referral Specialist - Clarkston Medical Group

The referrals specialist is responsible for referral operations, establishing and standardizing systems and procedures for the distribution and use of health information throughout the organization, coordinating and referral functions with all other departments.

Duties and responsibilities

• Ensures current and standardized referral policies and workflows.
• Prioritizes referrals by their urgency and addresses them in a timely manner.
• Participates in the selection, orientation and training of referral personnel.
• Ensures complete demographic, insurance information and appropriate/pertaining clinical information is sent to referred specialists.
• Contacts insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as, history, diagnosis and prognosis to insurance companies if deemed necessary to prove medical necessity of services.
• Reviews details and expectations about the referral with both ordering providers and patients. Requests new referrals to be ordered when applicable.
• Develops and implements systems as required by EMR functionality and/or regulatory agencies.
• Identifies and utilizes community resources; establishes relationships with servicing providers and personnel.
• Point of contact for patients and specialists for any questions or rising concerns.
• Performs other related duties as assigned

• High School Diploma or GED
• 2+ years' experience in handling referrals in a licensed medical facility
• Exceptional organizational skills
• ICD-10-CM coding capabilities
• Proficient in information management programs and MS Office
• Excellent interpersonal and organizational skills
• Strong attention to detail
• Outstanding communication and interpersonal abilities
• Proficient in computer programs, including Microsoft Office and Outlook
• Knowledge of medical terminology

• Schedule: Full-time
• Requisition ID: 26003283
• Daily Work Times: 8:00am-5:00pm
• On Call: No

Equal Opportunity Employer

McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.