Referrals Specialist

• Verifies insurance coverage via system tools, payer portals (Electronic Query (Real-Time-Eligibility [RTE]/Insurance Payer Portal/Phone).
• Upon verification of patient's insurance coverage, update changes in the billing system.
• Confirms providers participation status with patients insurance plan/network.
• Determines payer referral and authorization requirements for professional services.
• Contacts patient and PCP to secure payer required referral for planned services.
• Documents referral in practice management system.
• Research system notes to obtain missing or corrected insurance or demographic information.
• Initiates authorization and submits clinical documentation as requested by insurance companies.
• Manage faxes, emails, and phone calls in a timely manner.
• Responds to voicemails and emails within same business day of receipt.
• Serves as primary liaison between faculty practice/department, insurance companies and patient to verify eligibility and coordination of benefits and resolve any insurance complications.
• Performs other job duties as assigned.

• High school graduate or GED certificate is required.
• A minimum of 6 months experience in a physicians billing or third payer environment.
• Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
• Candidate must demonstrate strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and professional manner.
• Must demonstrate effective communication skills both verbally and written.
• Ability to multi-task, prioritize, document, and manage time effectively.
• Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
• Functional proficiency and comprehension of medical terminology.
• Ability to work independently and collaborate in teams.
• Experience in Epic and or other electronic billing systems is preferred.
• Knowledge of medical terminology, diagnosis and procedure coding is preferred.
• Previous experience in an academic healthcare setting is preferred.

Demonstrates proficiency in insurance verification, managed care eligibility, and medical terminology while effectively communicating with patients and insurance companies. Capable of managing multiple tasks and adapting to complex situations in a healthcare environment.

• Insurance Verification
• Managed Care Eligibility
• Medical Terminology
• Customer Service
• Epic Electronic Billing System

• Insurance Billing Requirements
• Pre-Authorizations
• Diagnosis Coding
• Procedure Coding
• Practice Management System Documentation

• Effective Communication
• Adaptability
• Time Management
• Problem Solving
• Team Collaboration

• High School Graduate
• GED Certificate

• Payer Portal
• Referral Management
• Patient Coordination
• Healthcare Setting
• Third Party Payer Environment

• Microsoft Word
• Microsoft Excel
• Microsoft Outlook
• Email
• Epic