Referral Specialist - EngageMED - On-Site

EngageMED, Inc.; North Little Rock (AR); On-site; USD 35,000 - 52,000; Full time

Job summary

Paycom - ATS is seeking a Referral Specialist to manage referrals, authorizations, and pre-certifications for specialty services. You will coordinate with physicians, patients, and payers to ensure timely reimbursement and accurate information flow.

The role requires high attention to detail, strong communication, and proficiency with Microsoft Office. Prior administrative or medical office experience is preferred. This is an on-site role in the United States.

Qualifications

• Must read, analyze, and interpret general business materials and regulations.
• Strong written communication for reports and procedures.
• Proficiency in Microsoft Office and data handling.
• Able to set up appointments and coordinate patient care.
• Ability to explain billing and insurance details clearly.

Responsibilities

• Gather, verify, and process referrals, authorizations, and pre-certifications with physicians, patients, and payers.
• Answer questions about health care plans including billing/insurance clarifications.
• Set up appointments and coordinate clinic visits, including special arrangements.
• Enter referrals and communications into the system; notify physicians/patients of denials or missing information.
• Maintain database of referral offices used by each physician; assist with complaint resolution.

Skills

Reading & analysis

Writing skills

Presentation skills

Numerical reasoning

Problem solving

Communication

Customer service

Education

High school diploma or equivalent

Tools

Microsoft Office Suite

Database management

Spreadsheet

Graphic presentation

Desktop publishing

Internet navigation

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.