General Summary:
Referral Specialists at Holston Medical Group are expected to be patient focused and team oriented individuals who ensure that provider consult orders are initiated and completed as directed. They must be organized and keep abreast of changes to insurance companies requirements for prior authorizations. The Referral Specialist is expected to be knowledgeable of medical terminology and ICD-9 coding. They are expected to research claims and communicate with insurance companies, patients and employees in physician offices. The person in this position must have excellent phone etiquette and attention to detail. The Holston Medical Group Referral Specialist is expected to be knowledgeable and kind to patients, co-workers and outside vendors alike. They should exhibit a professional attitude and provide excellent customer service.
Main Responsibilities:

• Initiate and complete consult orders as requested by physician, physician’s assistant or nurse practitioner
• Coordinate with internal/external physician offices and healthcare organizations as needed to complete patient referral
• Document all referral related information in the EMR (electronic medical record)
• Complete referral forms as needed per insurance requirements
• Communicate all necessary referral information (appointment scheduling information) to patient in a timely manner
• Research claims and communicate with insurance companies, patients and employees in physician offices
• Maintain quality levels that meet or exceed customer expectations through process improvement and a team oriented approach
• Maintain confidentiality in matters relating to patients
• Other duties as assigned

Education/Experience/Knowledge:

• High School diploma or equivalent required
• 2-3 years of work experience with increased responsibility in a medical office or hospital setting
• Experience and understanding of basic medical terminology
• Experience and understanding of health insurance with increased knowledge of managed care
• Experience and understanding of ICD-9 and CPT coding
• Prefer experience with Electronic Medical Records (EMR)
• Solid understanding of scheduling efficiency and patient flow in medical practice
• Excellent phone etiquette and attention to detail
• Must have strong Customer Service Skills