Referral Specialist

About This Role

The Referral Specialist coordinates the revenue cycle by processing pre-registration, registration, demographic, and financial verification activities. This role involves analyzing insurance plans, verifying eligibility, and communicating benefits information to patients for consultations and surgical processes.

Responsibilities

• Coordinate the front end of the revenue cycle by processing pre-registration, registration, demographic and financial verification activities
• Analyze insurance payor/plans and verify eligibility through Epic’s RTE platform or third-party websites
• Document responses of eligibility accurately in the patient’s medical record
• Coordinate verification of insurance benefits for all patients within 48 hours of seminar attendance
• Call patients within 72 hours of the seminar to communicate results of benefits verification and to schedule an initial consultation appointment
• Counsel patients with exclusions on self-pay and financing options
• Meet with each patient at the end of initial consultation appointment to discuss insurance and clinical requirements and the process to surgery
• Track patient status and enter all insurance and appropriate data in tracking tool
• Collaborate with bariatric patient navigators and other team members to ensure clear communication on insurance requirements, referring reason, patient preferences
• Track referrals, respond to referring providers, contact referred patients to initiate care and ensure referrals are completed properly

Requirements

• High School Diploma or GED (or 5 years medical clinic experience)
• 5 years customer service-related experience
• Experience working in a medical clinic setting
• Experience with ICD and CPT coding
• Strong computer skills
• Excellent judgment
• Excellent verbal and written communication skills
• Ability to accurately document patient status
• Ability to manage multi tasks/assignments simultaneously
• Ability to function as team member and promote teamwork

Qualifications

• High School Diploma or GED
• 5 years customer service-related experience, 5 years medical clinic experience (may be accepted in lieu of diploma)

Nice to Have

• 3 years working with insurance companies and obtaining authorizations
• Knowledge of EMR system

Skills

* Required skills

Benefits