Referral Specialist - Medical - Progressive Community Health Centers, Inc.
Wisconsin, WI
About the Job
Under the direction of the clinic manager, assists patients, providers, and clinical staff with the coordination of making contact and scheduling with a specialist or for a specific procedure. Additionally, specialists work with the insurance carriers to obtain prior authorization, if needed.
Both medical and dental referral specialists act as; the liaison to insure pleasant and prompt communications in the transition of care.
- Verifies insurance is correct
- Verifies that the referred specialists are in network with the current insurance plan; if not, redirect patient/provider to an in-plan provider
- Verifies specialist's appointments regarding insurance acceptance and obtains referrals if required.
- Initiates and manage clinical referrals for pre-authorization
- Acts as a liaison between hospital, health plans, provider, patients, vendors and other referrals sources.
- Reviews referrals for completeness and follows up for additional information if necessary.
- Verifies insurance coverage and completes pre-authorization process for ancillary procedures/testing.
- Maintain accurate follow-up files on patient involving pre-authorization indicating the date of the call, letter, or any correspondence that took place.
- Documents all actions related to the referral in the patient's chart, via EPIC.
- Informs providers and/or patients of any referral changes, denials, etc.
- Returns all phone calls and voicemails in a timely manner.
- Consistently documents and maintains patient charting to ensure accurate and organized documentation of
follow up to patient requests.
KNOWLEDGE and SKILLS
- 1. Knowledge of Medical terminology.
2. Ability to locate all insurance companies and comply with manuals.
Referral Specialist 2
3. Know the difference between pre-authorizations and referrals
4. Knowledge of universal precautions and blood borne pathogens
5. Ability to relate well to people from diverse ethnic and cultural backgrounds
6. Willingness to work flexible hours in order to meet patient care needs/demands.
- High school graduate or equivalent.
- At least 2 years of on-the-job training and/or experience with healthcare insurance in a clinic, physician's office or hospital setting.
- EPIC and previous referral experience preferred.
It is mandatory that all employees, employed providers and volunteers are vaccinated. All hired candidates must submit proof of vaccination prior to their orientation. This is a mandatory requirement for Progressive Community Health Centers. The purpose is to minimize exposure to and transmission of the influenza virus in the workplace by providing occupational protection to employees and thereby preventing exposure to members of the community, which we serve.
Equal Employment Opportunity: Progressive Community Health Centers is an equal opportunity employer and will not discriminate against employees or prospective employees on basis of age, race, creed, color, religion, marital status, sex, national origin, ancestry, citizenship, sexual orientation, disability, arrest and/or conviction record, military status, protected veteran status, or any other characteristic or status protected by law.
