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)
Description
The Referral Specialists 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 insure accurate billing. Liaison for the customer with Billing Department, Intake Department, and Therapists. A Referral Specialist has responsibility for obtaining basic information from persons 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 Team Leader to support administrative operations and delivery of clinical service.
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