Referral Specialist: Streamline Patient Care Access

CommonSpirit Health; Federal Way (WA); On-site; USD 36,000 - 52,000; Full time

Job summary

Virginia Mason Franciscan Health is seeking a Referral Specialist to orchestrate patient access to specialty care by managing referrals and authorization processes. You will obtain clearances for visits, issue referrals for ancillary services, and secure approvals for medications, DME, home health, and other vital services, while maintaining accurate patient records and communications.

The role requires meticulous attention to detail, strong organizational skills, and clear communication to

Qualifications

• Successful completion of an accredited medical terminology course(s) or equivalent on the job training, upon hire.
• One year of progressively responsible work experience demonstrating the requisite job knowledge/abilities.
• None, upon hire

Responsibilities

• Processes referral orders and/or pre-authorizations.
• Ensures insurance eligibility checks have been conducted on all referrals before the patient is seen, by escalation or direct verification.
• Completes referrals and/or pre-authorization for diagnostic testing, therapy, surgeries and specialty care.
• Provides information to patients regarding their health care plan and explains insurance policies to employees, physicians and members.
• Provides answers to billing and insurance questions; obtains a cost estimate when requested.
• Notifies physicians and patients if a referral is denied or needs additional info.
• Updates the patient’s medical record and scans documents into the EMR.
• Coordinates appointments and ancillary services; interacts with referring clinics as needed.
• Gathers insurance eligibility data and enters it into the patient’s EMR; verifies details in conversations.
• Contacts patients to confirm or reschedule referrals and documents no-shows per policy.
• Responds to routine billing and insurance questions and forwards complex queries to Financial Counselor.
• Coordinates patient educational materials related to the referral.

Skills

Medical terminology

Healthcare experience

None, upon hire

Education

Accredited medical terminology course

Job description

Virginia Mason Franciscan Health is seeking a Referral Specialist to orchestrate patient access to specialty care by managing referrals and authorization processes. You will obtain clearances for visits, issue referrals for ancillary services, and secure approvals for medications, DME, home health, and other vital services, while maintaining accurate patient records and communications.

The role requires meticulous attention to detail, strong organizational skills, and clear communication to