Referral Specialist processes insurance pre-verification for hospital admissions or specialty service office visits. Gathers pertinent information from patients, insurance carriers, financial counselors, and other staff to confirm the patient's financial obligations for services. Being a Referral Specialist acts as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals. Verifies insurance coverage and obtains required authorizations when necessary. Additionally, Referral Specialist documents referrals, communications, actions, and other data in an information management system. Generates and distributes all applicable forms, notifications, and paperwork. Requires a high school diploma. Typically reports to a supervisor. The Referral Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Referral Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
This position supports the SwedishAmerican Medical Group (SAMG) with the following processes:
Imperative to this role is the dedication and enthusiasm the employee must have each and every day, following all SwedishAmerican guidelines and protocols, from integrity, compassion and accountability, to respect and continued striving for excellence.
EDUCATION/TRAINING:
Associates Degree preferred with an emphasis on healthcare. At least 2 years of Customer Service experience required, preferably in a healthcare setting or with medical claims insurance. Knowledge of medical terminology and anatomy/physiology preferred.
EXPERIENCE/SKILLS/ABILITIES:
Must be detail oriented and well organized. Requires ability to multitask in a high volume, very technical and diverse environment. Position requires strong analytical and critical thinking skills. Effective communication & listening skills required. Excellent interpersonal and customer service skills with ability to interact with all levels of staff, patients, and diverse population required. Knowledge of medical terminology preferred. Ability to type 35 wpm preferred. Previous computer experience required.
Above average written communication skills are required.
Successful completion of annual job specific competencies and skill verification tools required.
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