Summary/Objective: A Referral Specialist is responsible for obtaining insurance referrals, prior authorizations, and pre-determinations that allow a patient to access the services of the Clinic’s health care providers.

Essential Functions

• Complete daily workload assignments, keeping to the department standard for productivity, for obtaining authorizations, referrals, or pre-determinations for clinic patients.
• Accurately process authorizations, referrals, and predeterminations per insurance carrier guidelines and clinical specialty requirements.
• Accurately document all actions taken to obtain authorizations, referrals, and pre-determinations in Clinic systems. This includes building referrals and signing off on reservations.
• Maintain clear and positive communications with physician offices and support staff to ensure efficient handling of referrals, authorizations, and pre-determinations.
• Attends departmental meetings (including the daily huddle) and keeps the processes of your assigned specialties up to date.

Required Education and Experience: High School Graduate or equivalent (GED and 4 years of related experience may be equivalent).

Preferred Education and Experience: One to two years referral, authorization, and pre-determination experience preferred. Prefer experience working with Epic, Athena/IDX, ICD-10, CPT / HCPCS codes, and proficiency with medical terminology

Additional Eligibility Qualifications: Knowledge of insurance plan referral requirements and referral processes. Ability to demonstrate excellent communication skills (oral and written). Ability to retain detailed information to perform daily duties and assist physician offices with proper referral processing. Ability to type 35wpm and have basic knowledge of IDX scheduling. Ability to multi-task in a fast paced environment and possess excellent organizational skills. Advanced telephone skills as a primary instrument of communication.