Referral Specialist - EngageMED

EngageMED, Inc.; North Little Rock (AR); On-site; USD 40,000 - 55,000; Full time

Job summary

Catholic Health Initiatives is seeking a Referral Specialist to manage referrals, authorizations and pre-certifications for patients requiring specialty care. You will work closely with physicians, patients and payers to ensure timely referrals and clear billing information.

The role involves setting up appointments, coordinating travel or interpreter services as needed, and maintaining accurate referral records.

Qualifications

• High school diploma or equivalent required.
• 2 years of progressively responsible related experience in a healthcare environment.
• Knowledge of clinic referral, scheduling, and billing/authorization requirements.
• Ability to communicate effectively and maintain confidentiality.
• Proficient with Microsoft Office Suite, Internet navigation, database management, spreadsheet, and graphic presentation packages.

Responsibilities

• Gather, verify, and process 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.
• Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patient.
• Enter referrals, documents communications and action into the system, as appropriate.
• Notify physician(s) and patient when referral is denied, or if additional information is needed.
• Develop and maintain database of referral physician offices preferred by each physician within the clinic.
• Assist Practice Manager with complaint resolution and solutions related to patient referrals.
• Perform other duties as assigned by the practice manager or physician.

Skills

Teamwork Orientation

Service Orientation

Achieves Results

Learning and Growth

Communication

Confidentiality

Multitasking

Education

High School Diploma or equivalent

Tools

Microsoft Office Suite

Internet navigation

Database management

Spreadsheet

Desktop publishing

Job description

Catholic Health Initiatives Job DescriptionJob Title: Referral SpecialistExempt Non-ExemptReports To:Supervisory Responsibility: YesNoGroup:Approval Date:Date Last Revised:I. Job Summary / Job Purpose (briefly state why does this job exist in 3-5 lines)The Referral Specialist works with patients requiring a referral, to ensure patient’s referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.II.Key Responsibilities (list 5-8)Gather, verify, and process 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.Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patient.Enter referrals, documents communications and action into the system, as appropriate.Notify physician(s) and patient when referral is denied, or if additional information is needed.Develop and maintain database of referral physician offices preferred by each physician within the clinic.Assist Practice Manager with complaint resolution and solutions related to patient referrals.Perform other duties as assigned by the practice manager or physician.III.CHI Core ExpectationsAt CHI, we expect all our employees to live the values of Reverence, Integrity, Compassion and Excellence at work by:Honoring and caring for the dignity of all persons in mind, body, and spiritEnsuring the highest quality of care for those we serveWorking together as a team to achieve our goalsImproving continuously by listening, and asking for and responding to feedbackSeeking new and better ways to meet the needs of those we serveUsing our resources wiselyUnderstanding how each of our roles contributes to the success of CHI.IV.Core Job CompetenciesCore CHI Behaviors: The following behaviors have been identified as critical to all staff roles at CHI:Teamwork Orientation: works cooperatively & collaboratively with others toward the accomplishment of shared goals.Service Orientation: desire to serve and focus one’s efforts on discovering and meeting the needs of internal and external customers.Achieves Results: reflects a drive to achieve and outperform. Continuously looking for improvements. Accepts responsibility for actions and results.Learning and Growth: has a commitment to continuous professional and organizational learningCommunication: practices attentive and active listening and can restate opinions of others; communicates messages in a way that has the desired effect.Role-Specific Behaviors: these additional behaviors are necessary in the role:Knowledge of clinic referral and scheduling processes and billing/authorization requirements.Knowledge of federal and state pay requirements, including Medicare, DSHS, HMO/PPO Contracts.Ability to communicate effectively and to maintain strict confidentiality.Ability to respond to people and issues promptly and appropriately, to resolve problems.A team player who handles multiple projects simultaneously in a fast paced environment.Possess a strong work ethic and a high level of professionalism.Skills, Knowledge or Abilities critical to this role:Language Ability: Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to common inquiries or complaints from groups of managers, clients, customers, and the general public.Math Ability: Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.Computer Skills: Must be proficient with the Microsoft Office Suite, Internet navigation, database management, desktop publishing, spreadsheet, and graphic presentation packages.V. Job Requirements / Qualificationsa. Education / Accreditation / Licensure (required & preferred):High school diploma or equivalent required.b. Experience (required and preferred):2 years of progressively responsible related experience in a healthcare environment required.