Referral Specialist

WFH opportunity

This position is responsible for all aspects of the referral process, which may vary depending on practice/department specialty. May perform Medical Receptionist duties as necessary.

• Educates patients and staff with pertinent referral and insurance information.
• Obtains pre-certifications and insurance authorizations for medical procedures.
• Generates referral information for physicians, patients and health plans.
• Acts as a liaison among providers, patients and health plan administrators.
• Relays clinical information to health plan case managers for special procedure pre-certification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up as necessary.
• Communicates referral status to patients and physicians; ensures that referrals have been processed accurately and in a timely manner to coincide with patient treatment plan.
• Assists patients in scheduling appointments with specialists, resolving billing discrepancies and any other referral issues.
• Supports other offices, attends required meetings and training, and participates in committees as requested.
• May perform Medical Reception duties as necessary.
• Assists with special projects and assumes additional duties as assigned.

• Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of both IHA and Trinity Health.
• Must be able to work effectively as a member of the reception team.
• Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers.
• Maintains knowledge of and complies with IHA standards, policies and procedures.
• Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems.
• Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines.
• Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
• Uses resources efficiently.
• Monitors, organizes and keeps work area and waiting room neat.

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

Education: Undergraduate degree or Associate’s degree in health care or a related field and specialized training or equivalent combination of education and experience.

Credentials/License: None

Minimum Experience: 4 years’ experience with insurance referrals, prior authorization or other relevant medical office experience.

• Knowledge of medical terminology and procedures at the level needed to perform responsibilities.
• Proficient knowledge of major health plans and insurance processes.
• Excellent written (legible), verbal and face-to-face communication skills, including ability to effectively explain relevant insurance information to patients, as well as communicate with insurance plans and internal customers. Proper phone etiquette.
• Proficient/knowledgeable in patient care procedures and organizational policies related to position responsibilities.
• Service-oriented; responsive to customer needs and courteous in approach.
• Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, Next Gen, Microsoft Word /Excel/Outlook, intranet and computer navigation.
• Ability to compute mathematical calculations.
• Ability to work independently and collaboratively in a team-oriented environment; displays professional and friendly demeanor.
• Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, vendors, outside customers and couriers.
• Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
• Good organizational and time management skills to effectively juggle…