Referral Specialist I (US)

Job Description Summary

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The Referral Coordinator I processes routine referrals and supports authorization activities while meeting quality and productivity standards

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How will you make an impact & Requirements

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Primary Responsibilities

• Initiates and processes routing clinical referrals and authorization requests following established procedures. 
• Serves as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources to support referral coordination.
• Reviews referrals for completeness and accuracy and follows up for additional information if necessary.
• Verifies insurance coverage and initiates pre-authorization requests in accordance with payer requirements and established workflows.
• Responds to inbound requests related to referral processing while meeting productivity and quality standards.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enters referrals, documents communications, actions and related information in system.
• Escalates complex referral issues or authorization concerns to senior referral coordinators or leadership as appropriate.

 

Minimum Qualifications

• High school diploma or GED and minimum of 1 year of customer service or healthcare administrative experience required; or any combination of education and experience which would provide an equivalent background.
• Medical Assistant certificate / certification from an accredited training program required.
• Knowledge of medical terminology, plan specific guidelines; ICD-9 and CPT coding preferred.

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Compensation Range:

$18.90

to

$28.35

 

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.