Referral Specialist

Job Details

Description

Handle incoming clinical tasks, phone calls, and in-person requests, reviewing clinical history and obtaining notes for provider when needed; ensuring correct payer, CPT, and ICD-10 codes are on referral requisition.
All referrals are processed in a timely and efficient manner and according to the referral policies and procedures; insurance benefit and eligibility is confirmed prior to processing the referral, ensuring patient is assigned to a SH provider.
Arrange appointments with external and internal specialties, faxing referral requisition and any pertinent information.
Patients, or parent/legal guardian, are notified verbally regarding their appointment date, time, location, special instructions, and out-of-pocket expenses if applicable.
Follow up on referrals pending prior authorization/appointment is done at least weekly, documenting all efforts made in EHR.
Use of good time-management skills; contributing to increased productivity.
Actively participating in staff meetings and working toward accomplishing department goals and objectives; ability to work well with team members. Accomplishing related results as needed.
Statistics of all referrals processed are reported weekly to the Practice Manager.
Use multiple software systems for insurance verifications and referral processing purposes.
Demonstrates an understanding of organizational structure by utilization of appropriate channels of communication regarding all facets of departmental activities.
Use of computers, fax/copy machines for the exclusive uses of clinic business; keeping work areas clean and organized at all times.
Adhere to HIPAA confidential practices for patient information.
Adhering to all Sunset Health policies and procedures.
Performs other duties as assigned.

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