Referral Specialist

Boone Memorial Health

Position Summary

Boone Memorial Health is seeking a Referral Specialist to join our healthcare team. The Referral Specialist is responsible for coordinating patient referrals, insurance authorizations, and appointment scheduling to ensure patients receive timely access to necessary healthcare services.

This position works closely with patients, families, physicians, providers, insurance companies, and healthcare professionals to coordinate referrals and assist patients in navigating the healthcare system.

Responsibilities

• Process and coordinate patient referrals accurately and efficiently.
• Obtain insurance authorizations and follow up on pending requests.
• Schedule patient appointments and coordinate services with providers and healthcare facilities.
• Verify and maintain accurate patient demographics and insurance information.
• Maintain referral records, tracking logs, and follow-up documentation.
• Monitor referral status and ensure referrals are completed in a timely manner.
• Respond professionally to patient, provider, and insurance inquiries by telephone and other communication methods.
• Document referral information accurately in CPSI/Medical Records and other required systems.
• Review patient logs and run reports to monitor referral activity.
• Assist patients and families with navigating the healthcare system and resolving referral-related concerns.
• Advocate for patients when working with insurance carriers to obtain approval for necessary services and supplies.
• Communicate referral information clearly to physicians, providers, staff, and other healthcare professionals.
• Maintain patient confidentiality and follow all applicable policies and procedures.
• Work cooperatively with coworkers, physicians, providers, and other members of the healthcare team.
• Perform other duties as assigned.

Qualifications

• High school diploma or GED required.
• Minimum of two (2) years of experience with patient referrals, medical scheduling, insurance authorizations, or a related healthcare function required.
• Previous experience in a physician practice, hospital, clinic, or other healthcare setting preferred.
• Knowledge of medical terminology and commonly used medical abbreviations.
• Knowledge of diagnosis and CPT-10 coding.
• Knowledge of insurance authorization and referral processes.
• Strong organizational and time-management skills.
• Excellent communication and interpersonal skills.
• Strong attention to detail and accuracy.
• Ability to work independently and manage multiple tasks and deadlines.
• Basic computer and word-processing skills.
• Ability to provide professional and courteous customer service.
• Strong problem-solving and patient advocacy skills.

Physical Requirements

The position requires the ability to sit or stand for extended periods and perform activities including walking, reaching, bending, twisting, pushing, pulling, squatting, grasping, and lifting up to 25 pounds using proper lifting techniques.

Supervisory Responsibilities: None
Travel Required: None

Equal Employment Opportunity

Boone Memorial Health provides equal employment opportunities to all personnel and applicants for employment and prohibits discrimination, harassment, prejudice, or behavior of any type based on race, color, religion, age, sex (including pregnancy), national origin, disability status, family medical history or genetic information, past or present military service, sexual orientation, gender identity or expression, family or parental status, political affiliation, or any other characteristic protected by federal, state, or local laws.