Referral Specialist

Primary Job Function

A 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. acts as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals. Verifies insurance coverage and obtains required authorizations. Additionally, Referral Specialist resolves pre-certification, registration, and case-related issues.

Documents referrals, communications, actions, and other data in an information system. Generates and distributes all applicable forms, notifications, and paperwork.

• Works in our EHR to receive referrals from providers.
• Process referrals according to the orders.
• Obtains prior authorization for payment from the patient's insurance4 company.
• Secures appointment with other providers, lab, radiology, etc..
• Communicates with the patient to verify appointment time and any information they may need to take to the appointment.
• Communicate effectively with all providers and office staff to ensure that everyone is aware of necessary information related to patient care.

• Demonstrates clinical competency as identified by certifications and training.
• Assumes responsibility for own continued personal and professional development.
• Appropriate manner, conduct y and grooming.
• Ability to work cooperatively and communicate effectively.
• Good health and consistent attendance
• Working knowledge of basic computer skills.

• Current LPN license required
• Clinic experience preferred

• Receive referrals through the HER from providers at THMH.
• Verify insurances by using various websites, phone and fax.
• Establish appointments with appropriate facility, office, physician.
• Notify patient of appointment time and any additional information that is needed for procedure/appointment.