Referral Specialist

Description

The Referral Specialist manages and facilitates patient referrals, authorizations, and scheduling appointments, tests, and procedures at designated locations. Serving as a liaison between patients, providers, and medical support staff, the referral specialist ensures timely coordination of care by verifying insurance eligibility, obtaining prior authorizations, and entering necessary demographic and insurance information into clinic and hospital systems. The role also includes handling phone communications, supporting referral management operations, and adhering to the mission, vision, and performance expectations of Mercy One Medical Group.

Full time

Day Shift

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
• Works directly with patients, families, insurance representatives, physicians, and vendors to facilitate the referral process.
• Coordinates, processes, and tracks patient referrals, authorizations, and scheduling with accuracy and attention to detail.
• Verifies insurance coverage, obtains prior authorizations, and communicates approval/denial to patients.
• Schedules patient appointments with appropriate specialists and providers, ensuring timely communication of appointment details.
• Maintains accurate documentation of referrals, prior authorizations, communications, and patient scheduling in the EMR system.
• Assists patients with insurance verification, prior authorizations, and required documentation for medical services and tests.
• Communicates and follows up with insurance companies, providers, and patients regarding referral status, appointments, and test results.
• Must be comfortable operating in a collaborative, shared leadership environment.
• High school diploma or equivalent required.
• Minimum of 1 year of relevant experience in a healthcare setting required, with prior medical office experience preferred.
• Knowledge of ICD, CPT coding, medical terminology, and healthcare billing/authorization processes is preferred.
• Ability to maintain confidentiality and adhere to HIPAA regulations.
• Must be able to communicate effectively, both verbally and in writing, and demonstrate proper telephone etiquette.

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.