Referral Specialist
Referral Specialist
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Job Description
Currently we are seeking a highly organized and detail-oriented individual to join our team as a Referral Specialist. This team member will coordinate process and schedule medical referrals and prior authorizations for various medical or surgical services/ procedures for clinic patients as requested by clinic providers. This requires clinical knowledge and understanding of CPT and ICD-9(10) codes to meet the requirements of third-party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations. This position requires clinical and administrative judgment and initiative to determine the best approach for urgent and non-urgent patient care needs.
Essential Job Duties:
- Obtain knowledge of changes in insurance policies referral guidelines and healthcare regulations to ensure compliance and provide accurate information to patients and providers.
- Assess referral requests from providers to determine the appropriateness and completeness of the information provided.
- Enter and maintain accurate comprehensive data entry of all referrals into the electronic medical record.
- Confirm the patients insurance coverage and obtain any necessary authorizations or pre-certifications for the referral to ensure that the services will be covered.
- Schedule appointments with the appropriate specialists based on the patients needs and availability.
- Collaborate with providers specialists and other staff to ensure seamless coordination of care and exchange of necessary medical records.
- Communicate and offer support and guidance to patients throughout the referral process addressing any questions or concerns they may have and provide excellent patient experiences and delivery of care.
- Monitor the progress of referrals and follow up with patients providers and insurance companies to ensure timely completion and resolution of the referral process.
- Address any challenges or concerns that may arise during the referral process such as scheduling conflicts insurance denials or delays and working to find appropriate solutions.
- Assist with training staff on the process of managing referrals ensuring efficient coordination and seamless communication between patients providers and insurance companies.
- Participate in quality improvement initiatives as part of the practice care team.
- Be a positive role model for all health center staff.
- Other duties as assigned.
Third Street is an equal opportunity employer. Our goal is to be a diverse workforce that is representative at all job levels of the communities and patients we serve. We do not discriminate on the basis of race color religion marital status age national origin ancestry physical or mental disability medical condition pregnancy genetic information gender sexual orientation gender identity or expression veteran status or any other status protected under federal state or local law. If you require reasonable accommodation in completing this application please direct your inquiries to or call ext. 2201 for Human Resources.
What We Offer:
Attending to your needs today:
- Your ideas input and contributions are valued and recognized.
- Excellent clinical administrative and management support
- Forward-thinking collaborative transparent and inclusive company culture
- Employee Assistance Program
- Competitive Medical Dental and Vision plans
- Competitive compensation
- Paid Time Off
- Wellness Reimbursement Program
- Tuition assistance
Protecting your future:
- Medical dental and vision insurance
- 403(b) retirement plan with match
- Employer-paid life insurance
- Employer-paid long-term disability
Qualifications:
- High School Education or higher.
- Medical Assistant (MA) certificate preferred.
- Customer Service: minimum 1 year preferred
- Medical Office or Acute Care: 1 year preferred
- Previous experience in a medical office surgery scheduling setting preferred
- Previous experience in an insurance verification/admitting/patient registration setting preferred.
About Us:
Third Street is a patient-centered medical home driving change in the community. We adapt to the needs of those we serve while building services to fill gaps in care to invest in a healthier future for all. At Third Street we provide high-quality care through the continual learning of our employees and by building a diverse team. We value our employees communicate our expectations and train our team on best practices.
Organizational Information:
- Established in 1994 Third Street Family Health Services is a regional not-for-profit community health center providing medical dental OB/GYN pediatric community outreach and behavioral health services across eleven locations in Richland Marion Ashland and Crawford counties. Our mission is to deliver comprehensive health and wellness care accessible to all in the communities we serve. We believe that the health status of our community can be improved by providing accessible and affordable health care advocacy and community health initiatives.
- We provide patient-centered care and provide our services with respect integrity and accountability top of mind. For more information visit or find them on Facebook or Twitter.
Mission:
To deliver comprehensive health and wellness care accessible to all in the communities we serve.
Required Experience:
Unclear Seniority
Employment Type
Full Time
