Referral Specialist

Description

Job Summary: The Referral Specialist serves as a gatekeeper for initial point of entry for clients receiving outpatient services. Gathers, assembles, and maintains client and insurance billing information necessary to ensure accurate billing. Acts as a customer liaison with Billing Department, Intake Department, and Therapists. A Referral Specialist has responsibility for obtaining basic information from people requesting clinical appointments. Determines whether the individual needs an emergency appointment or can be scheduled with an outpatient clinician. A Referral Specialist works closely with the client, Billing Department, Insurance companies, and therapists to collect any available funds due for services rendered to the client. A Referral Specialist performs duties under the supervision of the Director to support administrative operations and delivery of clinical service.

Responsibilities:

1. Initial point of referral by clients requesting services by phone.
2. Organizes and performs functions necessary to ensure prompt and accurate billing and accounting of client accounts receivable for outpatient and case management departments for clients.
3. Advises client if they must call for pre-authorization to initiate service and gives information on that procedure as well as explains co-payments and benefits.
4. Responsible for performing tasks dealing with collecting fees for clients both active and closed.
5. Works with billing and/or Benefits, to help answer client questions regarding billing, i.e., statements received, payment postings, insurance requests or insurance denials.
6. Provides positive interaction in all contacts (clients, third party insurers, etc., and demonstrates sound judgment in her/his actions. Demonstrates sensitivity toward clients and visitors and actively promotes the agency theme and philosophy of courtesy, sensitivity, and respect.
7. Performs office tasks to ensure responsible, orderly, and efficient office operations.
8. Demonstrates efficient and effective use of the internal office communication system including coverage of the telephone switchboard, use of staff mailboxes, E-mail, and the use of the answering service to ensure that all communications are delivered accurately and promptly.

Requirements

• High school diploma or equivalent.
• Ability to organize office systems and procedures in an efficient and cost-effective manner in accordance with agency program policies.  
• Ability to exercise good judgment in individual situations to determine action to be taken within the limits of agency and program policies, procedures, standard practice.  Ideal candidate will have critical thinking skills and experience working in community mental health setting.
• Ability to write legibly and coherently, type and proofread accurately.  
• Good knowledge and use of English grammar as well as standard typing formats.  
• Ability to prioritize job responsibilities, to make sound independent judgments in routine situations and to know when to refer matters appropriately to the clinical staff or Director.  
• Desire to learn and the ability to accept supervision professionally.
• Ability to operate telephone system, computer, photocopier, calculator, and fax machine.