Referral Specialist

Job Profile Summary

This position is responsible for scheduling and obtaining authorization/pre-certifications for, but not limited to MRI, CT, Neurology, Pain Management and other specialized testing as well as referrals to other MD Specialists and for detailing all patient and third party interaction in the patient’s EMR. Promotes and provides customer satisfaction and appropriateness of care for all assigned patients.

Reports To: Practice Administrator

Essential Responsibilities:

• Greets all patients, whether in person or via the telephone, with a cheerful and helpful attitude.

• Provides coordination of testing to be performed with physician, patient, facility and payer. This includes reviewing medical documents for clarity, ensuring all necessary clinical steps have been taken; works with necessary parties to obtain third-party approval.

• Obtains all procedure and diagnosis codes to properly authorize/pre-certify ordered testing.

• Refers self-pay and out-of-network patients to the appropriate resource to help with payment.

• Complete pre-certification/authorization with the patient’s insurance company providing any necessary documentation.

• Document authorization/pre-certification once received along with contact information of the person spoken with.

• Contacts the patient and notifies them of the scheduled procedure and all necessary instructions.

• Coordinates with the hospital or facility the arrival times of each scheduled patient and contacts them with this information.

• Assists in reviewing and revising policies and procedures pertaining to scheduling function.

• Performs other responsibilities as necessary to ensure efficiency within the practice.

• Maintains operational knowledge of department equipment: telephones, computers, faxes, copier, printers, etc.

Age Specific Care:
Provides age and culturally appropriate assessment, interpretation of clinical and laboratory data and develops and implements age appropriate interventions and plans of care including education within the parameters of his/her position responsibilities and licensure. Ensure staff considers age related concerns such as: hearing, vision, speech and level of understanding, when interacting with patients, employees and families.

Minimum Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Training: High school diploma or GED certificate required, AAS in related field most helpful.

Licensure/Certification: none

Experience/Skills/Abilities: Proficiency with computer software applications including Excel and Word. Ability to maneuver through computer programs and general comfort with technology. Medical terminology preferred. Orthopedic terminology highly preferred. Ability to multitask and work in a fast paced environment. Must have excellent work habits, including a willingness to work the necessary hours to get the job done.