Referrals Specialist III #Full Time

61st Street Service Corporation; New York (NY); Remote; Full time

Job summary

An established industry player is seeking a dedicated Referrals Specialist III to join their dynamic team. This role is pivotal in ensuring patients receive timely insurance referrals and authorizations, crucial for their healthcare journey. The ideal candidate will thrive in a fast-paced environment, demonstrating exceptional customer service and communication skills while navigating complex insurance processes. With opportunities for growth within the Revenue Cycle Career Ladder, this position offers a chance to make a significant impact in a supportive and collaborative atmosphere. If you are motivated, detail-oriented, and ready to contribute to a vital healthcare service, this opportunity is perfect for you.

Benefits

Healthcare Benefits

Paid Time Off

Training and Development

Flexible Work Hours

Qualifications

• 2+ years experience in billing or third-party payer environment required.
• Strong understanding of managed care eligibility and insurance billing.

Responsibilities

• Verify insurance coverage and secure required referrals for services.
• Assist with training and quality audits while managing daily assignments.

Skills

Customer Service

Insurance Billing

Managed Care Eligibility

Communication Skills

Multi-tasking

Time Management

Problem-solving

Education

High School Diploma or GED

Tools

Microsoft Word

Microsoft Excel

Outlook

Epic

Job description

Career Opportunities with 61st Street Service Corp

Current job opportunities are posted here as they become available.

The 61st Street Service Corporation provides administrative and clinical support staff for ColumbiaDoctors. This position will support ColumbiaDoctors, one of the largest multi-specialty practices in the Northeast. ColumbiaDoctors’ practices comprise an experienced group of more than 2,800 physicians, surgeons, dentists, and nurses, offering more than 240 specialties and subspecialties.

This position is primarily remote; candidates must reside in the Tri-State area.

Note: There may be occasional requirements to visit the office for training, meetings, and other business needs.

Opportunity to grow as part of the Revenue Cycle Career Ladder!

Job Summary:

The Referrals Specialist III is responsible for verifying insurance policy benefit information and securing payer-required referrals. This position is responsible for obtaining accurate and timely insurance referrals for professional services prior to the patient’s visit. This position may also be required to obtain prior authorizations for scheduled services, as needed. The Referrals Specialist III is also responsible for assisting management with daily work assignments, staff training, and quality audits.

Job Responsibilities:

1. Verifies insurance coverage via system tools, payer portals (Electronic Query (Real-Time-Eligibility [RTE]/Insurance Payer Portal/Phone).
2. Upon verification of patient's insurance coverage, update changes in the billing system.
3. Confirms provider’s participation status with patient’s insurance plan/network.
4. Determines payer referral and authorization requirements for professional services.
5. Contacts patient and PCP to secure payer-required referral for planned services.
6. Documents referral in practice management system.
7. Research system notes to obtain missing or corrected insurance or demographic information.
8. Initiates authorization and submits clinical documentation as requested by insurance companies.
9. Manage faxes, emails, and phone calls in a timely manner. Responds to voicemails and emails within the same business day of receipt.
10. Serves as primary liaison between faculty practice/department, insurance companies, and patient to verify eligibility and coordination of benefits and resolve any insurance complications.
11. Assists Supervisor with special projects and/or tasks.
12. Assists Referrals Specialist I and II with complex cases or questions pertaining to the clearance of payer referrals, authorization, or insurance eligibility issues.
13. Assist supervisor/manager with distribution of daily work assignments.
14. Assist with new-hire training and staff refresher training materials.
15. Monitor and replenish the unit’s office supply needs.
16. Assist management team with performing periodic quality audits.
17. Perform other job duties as assigned.

Job Qualifications:

1. High school graduate or GED certificate is required.
2. A minimum of 2 years’ experience in a physician’s billing or third-party payer environment.
3. Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
4. Candidate must demonstrate strong customer service and patient-focused orientation and the ability to communicate, adapt, and respond to complex situations, including the ability to diffuse complex situations in a calm and professional manner.
5. Must demonstrate effective communication skills both verbally and in writing.
6. Ability to multi-task, prioritize, document, and manage time effectively.
7. Functional proficiency in computer software skills (e.g., Microsoft Word, Excel, Outlook, E-mail, etc.).
8. Functional proficiency and comprehension of medical terminology.
9. Ability to work independently and collaborate in teams.
10. The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.
11. Experience in Epic and/or other electronic billing systems is preferred.
12. Knowledge of medical terminology, diagnosis, and procedure coding is preferred.
13. Previous experience in an academic healthcare setting is preferred.

Hourly Rate Ranges: $27.40 - $36.06

Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training, and education.

61st Street Service Corporation

At 61st Street Service Corporation, we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive benefits package to eligible employees, including healthcare and various other benefits including paid time off to promote a healthy lifestyle.

We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.