Health Referral Specialist

• Position Summary

  • Completes daily review of physician orders for outside referrals and diagnostics. Processes outgoing referrals to other specialty physicians, providing documentation for referral to include insurance information. Schedules patients for diagnostic testing as ordered. Completes necessary prior authorizations required for referrals or testing. This position requires working knowledge of other clinic roles and provides assistance in those roles as needed, included but not limited to front office staff backup and clinical area assistance. Integrates customer service with various types of telephonic and electronic tools to ensure a positive patient experience.

• Education

  • Associates Degree or in lieu of a degree a minimum of 2 years of college - Required

• Experience

  • 2-3 Years Medical Office - Required
  • 1-2 Years Prior Authorization Management - Preferred

• License & Certification

  • Professional Certification (CMA, PCT or CNA) - Preferred

• Core Job Functions

  • Monitors physician orders for patient referrals to diagnostic departments, specialists, and initiates referrals; facilitates with CBO the pre-certification process, contacts patients when necessary; provides feedback to providers as needed if delays occur, and maintains outstanding results list to assure patient compliance with physician orders.
  • Assists to assure provider order entry and supportive care protocols are completed in a timely manner to meet patient expectations, clinical team needs, scheduling, and billing.
  • Refers patients to correct laboratory, imaging center, hospital or specialist. Ensures precertification is obtained when needed prior to services being rendered. Follows referral process based upon insurance company's policies and procedures. Notify patients of any delays in approval or whenever necessary.
  • Manage insurance pre-certifications and authorizations for all home sleep study’s and overnight oximetry’s scheduled for both LCRP and Bluffton locations. Provides timely notice to patients regarding balances due or delays in approvals. Facilitates in the rescheduling of appointments when necessary and provides communication regarding balances or scheduling to clinical team.
  • Manage patient authorizations as needed to assist with scheduling and claims management. Provides timely follow up on all inquiries and requests regarding authorization issues.
  • Provide clerical support to the office. Answer phones, complete patient requests, and route calls appropriately.
  • Assist in the coordination of care as directed by clinical managers. Including providing coverage for office staff (i.e. medical records, office coordinators) as requested by office manager.

Location: St. Joseph's/Candler · CH - Advanced Thoracic Oncology Center
Schedule: Full Time, Days, 8:30am-5:00pm