Referral Specialist

Position Purpose

This position's primary function is to process authorization requests timely and accurately in accordance with federal, state and accreditation guidelines. This position will be responsible for the completion of authorizations, including but not limited to data entry of information received by phone, fax or electronically, verification of member eligibility, benefit coverage, coordination of benefits information, communication of the members' plan benefits and/or exclusions to physician offices and collection of pertinent clinical documentation.

The Referral Specialist works closely with the Care Coordinators and Case Managers to provide appropriate utilization of resources, timeliness of treatment and quality of care. The Referral Specialist provides patient communication, pre‑registration, supports scheduling appointments, and payment collection as necessary. The Referral Specialist does not make medical necessity determinations.