Referral Specialist, Ophthalmology, FT, Days

Prisma Health; New York (NY); On-site; USD 34,000 - 46,000; Full time

Job summary

Prisma Health invites applications for a referral coordinator to streamline patient entry and ensure accurate authorization for consultations and tests. You will interface with patients, physician offices, and third-party payors to transmit documentation and secure approvals.

The role requires adept knowledge of medical terminology, CPT/diagnosis coding, and HIPAA compliance. You will document all interactions, follow up on referrals, and maintain smooth scheduling across multiple systems.

Qualifications

• Education - High School diploma or equivalent preferred.
• Two (2) years of related work experience in a physician front office preferred.
• Experience with patient registration, electronic scheduling, and authorization/precertification is preferred.

Responsibilities

• Coordinate with outside and internal organizations and insurance companies to obtain prior approvals.
• Record demographic, coverage, and scheduling information in the system.
• Remind patients of appointments via mail, internet, or phone.
• Document referral status and scheduled appointments in the EMR for tracking.
• Act as liaison between provider, patient, and specialist; share necessary clinical information.
• Verify orders and communicate guidelines and location to patients.
• Assist patients with navigating healthcare, financial obligations, or social barriers.
• Respond to scheduling requests and ensure timely, efficient referrals.
• Maintain patient confidentiality per HIPAA and Prisma Health policies.
• Ensure efficient operation of the facility and enhance patient experiences.
• Performs other duties as assigned.

Skills

Customer service

Communication

Interpersonal skills

Health insurance knowledge

Medical terminology

CPT/Diagnosis Coding

Microsoft Office

Education

High School diploma or equivalent

Tools

Microsoft Office

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Provides patients a seamless entry into the Prisma Health experience. Interfaces with patients and physician office team members to accurately authorize various consultations, procedures and tests. Utilizes each patient’s preferred method of contact. Utilizes various electronic medical records to transmit required clinical documentation to third party payors and Specialist Physicians. Responsibilities include documenting all actions and encounters regarding the referral including timely follow up with the patient, referring and referral physician practice and third-party payors including pre-certification, cancelled and rescheduled appointments, and other events preventing closure of the referral experience.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health’s purpose: Inspire health. Serve with compassion. Be the difference.

• Responsible for the authorization/precertification process to include coordinating with outside and internal organizations along with insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis and prognosis. Provides specific medical information to financial services to maximize reimbursement to the hospital and physicians.

• Records demographic, coverage, and scheduling information in various systems. Reminds patients of scheduled appointments via mail, internet, or telephone. Ensures that patient’s primary care chart is up to date with scheduling information about specialist consults, tests, and procedures managed. Alerts management to trends in appointment availability and appointment date timeliness.

• Promotes hospital goals towards meaningful use in the electronic medical record on behalf of the referring physician. Documents referral status and all scheduled appointments in appropriate system (electronic medical record) for referral tracking data. Responsible for following up after patient’s consultation, procedure, and/or test to determine if physician has received report; continues to check on status until complete.

• Serves as liaison between the provider, practice, patient and specialist providing the service. Provides appropriate patient clinical information and referral needs to specialist office.

• Verifies physician’s orders to ensure the accuracy of results and communicates with the patient the guidelines, protocols and location.

• Assists patients in problem solving potential issues related to navigating the health care system, financial obligations or social barriers (e.g., request interpreters if appropriate, transportation services or prescription assistance). May assume advocate role on the patient’s behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.

• Responds to patient’s scheduling requirements (date and time), questions and concerns to ensure patient experience expectations are met or exceeded.

• Ensures timely appointments are booked, reviews details and expectations about the referral process with patients.

• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by Prisma Health.

• Ensures the effective and efficient operation of the facility and to create an extraordinary patient, physician and team member experience.

• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Experience

• Education - High School diploma or equivalent preferred

• Experience - Two (2) years of related work experience. Experience in a physician front office to include patient registration and/or electronic scheduling and the authorization/precertification process preferred

In Lieu Of

• In lieu of education/experience noted above, equivalent work and/or experience may be considered (i.e., Associate degree or higher level of education)

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills or Abilities

• Customer service skills

• Communication skills

• Interpersonal skills

• Knowledge of various health insurance companies.

• Knowledge of medical terminology, CPT and Diagnosis Coding, insurance verification and updates, and the authorization/precertification process.

• Knowledge of Microsoft office products.

Work Shift

Day (United States of America)

Location

Richland

Facility

Ophthalmology 4 Med Park

Department

Ophthalmology 4 Med Park-Practice Operations

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.