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)
Referral Specialist
FULL TIME - 80 hours biweekly
8AM TO 4:30 PM
Under the general direction of the Practice Supervisor/Manager, serves as the primary resource for arranging and scheduling authorized patient referrals to specialists for diagnostic procedures and surgery. Obtains necessary pre-authorization approval and refers patients to authorized providers as required by the insurance company to ensure that patients' medical needs are met in a timely and professional manner. In some units, will verify current insurance coverage, contact insurance company to determine coverage and benefits, deductibles and any other requirements and obtain necessary approval from insurance company to assure proper payment.
Minimum Qualifications:
Education - Graduation from high school with commercial, business courses or equivalent.
Experience - Previous experience as a referral specialist preferred.
Licensure/Certification - BLS (CPR) certification in compliance with policy preferred.
Knowledge/Skills/Abilities - Must possess organizational and communication skills.
Strength Through Diversity
Meritus Health believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Meritus Health, and we expect a record of achievement and advancement as we meet our mission.
Our commitment to equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to create joy at work and reach their potential.
Happy to Help
At Meritus, we believe in a collaborative and caring work environment. Interactions are an opportunity to learn, listen and to be there for one another. Therefore, we provide warm welcomes, hospitality-driven closures, and are always Happy to Help.