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)
The Referral Clerk is responsible for assisting clinical staff members with making outside specialty referral appointments which may include obtaining pre-authorizations as necessary, gathering and sending additional pertinent information along with the referral order, tracking the referral to make sure the appointment was kept and that the information from the completed referral appointment was received back to the Crossing Healthcare ordering provider. The Referral Clerk works closely with all clinical staff members and reports directly to the Nursing Supervisor and/or Clinical Director.
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