Referral Specialist - EngageMED

Priority Dispatch Corp.; North Little Rock (AR); On-site; USD 32,000 - 42,000; Full time

Job summary

Priority Dispatch Corp. is seeking a Referral Specialist to ensure referrals, authorizations, and pre-certifications for specialty service visits are completed accurately and timely.

You will gather and verify information, coordinate clinic visits, answer billing and insurance questions, and maintain a referral database to support physicians and patients throughout the care process.

Qualifications

• High school diploma or equivalent required; healthcare experience preferred.
• Experience in administrative or medical office settings is desired.
• Familiarity with referrals, authorizations, and insurance processes is a plus.
• Strong written and verbal communication; ability to explain billing details clearly.

Responsibilities

• Gather, verify, and process referrals, authorizations, and pre-certifications with physicians, patients, and payers.
• Communicate questions and answers about health care plans and billing to patients.
• Set up appointments and coordinate clinic visits and special arrangements such as transportation.
• Coordinate information flow between clinic and referral authorization to secure valid referrals.
• Enter referrals and communications into the system and notify physicians and patients of denials or needed information.
• Develop and maintain a database of referral offices preferred by each physician.
• Assist Practice Manager with complaint resolution related to patient referrals.

Skills

Medical office experience

Referral processing

Customer service

Data entry

Communication skills

Problem solving

Education

High school diploma or equivalent

Tools

Microsoft Office

Internet navigation

Database management

Spreadsheet

Desktop publishing

Graphic presentation

Job description

Position: Referral SpecialistDepartment: Revenue CycleFLSA Status: Non-ExemptReports To: Revenue Cycle ManagerJOB DESCRIPTIONJOB SUMMARY: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.Supervisory Responsibilities:NoneSafety Sensitive Role:NoDuties/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.Required Skills/Abilities: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.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.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.Education and Experience:High school diploma or equivalent required.1–2+ years of experience in an administrative, or medical office setting preferred.Familiarity with clinical roles or healthcare environments is a plus.Physical Requirements:Prolonged periods of sitting at a desk and working on a computer.Must be able to lift up to 15 pounds at times.Disclaimers:This job description reflects assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.Critical features of this job are listed above and are subject to change at any time.Coworker Print Name:_______________________________________________Coworker Signature:________________________________________________ Date: ___________________________