Referral Specialist - Full Time

Watson Clinic LLP; Lakeland (FL); On-site; USD 34,000 - 52,000; Full time

Job summary

Watson Clinic LLP in Lakeland, FL is seeking a Referral Specialist responsible for obtaining insurance referrals, prior authorizations, and pre-determinations to ensure patients access services of our health care providers.

You will process authorizations per carrier guidelines, document all actions in Clinic systems, and maintain clear communications with physician offices. Preferred experience includes Epic, Athena/IDX, ICD-10, CPT/HCPCS, and medical terminology knowledge.

Qualifications

• High School Diploma or GED; 4 years related experience may substitute.
• Excellent communication skills (oral and written).
• Typing 35 wpm.
• Knowledge of insurance referral requirements.
• Experience with Epic, Athena/IDX, ICD-10, CPT/HCPCS codes preferred.

Responsibilities

• Process authorizations, referrals, and pre-determinations per carrier guidelines.
• Document actions in clinic systems; build referrals and sign off on reservations.
• Maintain clear communications with physician offices and support staff.
• Attend departmental meetings and keep processes up to date.
• Complete daily workload assignments for referrals and authorizations.

Skills

Attention to detail

Communication skills

Typing 35 wpm

IDX scheduling knowledge

Multi-tasking

Education

High School Diploma or GED with 4 years related experience

Tools

Epic

Athena/IDX

IDX scheduling

ICD-10/CPT codes

Job description

Full-time Description

Summary/Objective:

A Referral Specialist is responsible for obtaining insurance referrals, prior authorizations, and pre-determinations that allow a patient to access the services of the Clinic’s health care providers.

Essential Functions

• Complete daily workload assignments, keeping to the department standard for productivity, for obtaining authorizations, referrals, or pre-determinations for clinic patients.
• Accurately process authorizations, referrals, and predeterminations per insurance carrier guidelines and clinical specialty requirements.
• Accurately document all actions taken to obtain authorizations, referrals, and pre-determinations in Clinic systems. This includes building referrals and signing off on reservations.
• Maintain clear and positive communications with physician offices and support staff to ensure efficient handling of referrals, authorizations, and pre-determinations.
• Attends departmental meetings (including the daily huddle) and keeps the processes of your assigned specialties up to date.

Requirements

Required Education and Experience:

High School Graduate or equivalent (GED and 4 years of related experience may be equivalent).

Preferred Education and Experience:

One to two years referral, authorization, and pre-determination experience preferred. Prefer experience working with Epic, Athena/IDX, ICD-10, CPT / HCPCS codes, and proficiency with medical terminology

Additional Eligibility Qualifications:

Knowledge of insurance plan referral requirements and referral processes. Ability to demonstrate excellent communication skills (oral and written). Ability to retain detailed information to perform daily duties and assist physician offices with proper referral processing. Ability to type 35wpm and have basic knowledge of IDX scheduling. Ability to multi-task in a fast paced environment and possess excellent organizational skills. Advanced telephone skills as a primary instrument of communication.