Referral Center Specialist
On-siteFayetteville, North Carolina, United States
Job Summary
Answer phones, route calls, and take accurate messages while demonstrating urgency regarding patient distress. Schedule patient appointments with specialty providers, process necessary referral forms, and transfer patient information. Review insurance to obtain authorizations for diagnostic testing, office visits, and procedures, then review clinical data to provide information to insurance companies. Effectively communicate with the clinical team when an authorization is denied and maintain referral records in Epic, ensuring all data fields are completed. Open and distribute incoming mail to appropriate parties. Requires high school graduation, 1-2 years of medical insurance experience, and proficiency with EMR systems like Epic.
Required Qualifications
- High school graduate
- Must be capable of cross training
- Must be capable of adapting to electronic medical records in a clinic setting
- Must demonstrate progressive efficiency with this method of technology
- Must be able to answer phones
- Must be able to route calls
- Must be able to take accurate messages
- Must be able to adapt to a phone menu if one is in use
- Must demonstrate a sense of urgency relating to patient's level of distress
- Must be able to schedule patient appointments with specialty providers
- Must be able to process necessary referral forms
- Must be able to transfer patient information
- Must be able to review insurance to obtain authorizations for diagnostic testing, office visits, procedures, etc.
- Must be able to review clinical data to provide insurance company with information needed for authorization
- Must be able to effectively communicate with the clinical team when an authorization is denied
- Must be able to maintain referral record in Epic
- Must ensure referral data fields are completed
- Must be able to open and distribute incoming mail to appropriate parties
- Must attend meetings as required
- 1-2 years of medical insurance experience
- Experience obtaining authorizations and referrals
- Medical office experience
- Experience with EMR systems
- Office automation skills
- Extensive knowledge of CPT and ICD-10 coding and authorizations
- Strong interpersonal and verbal communication skills
- Good organizational skills
- Committed to and demonstrates excellent customer service when dealing with all types of customers
Desired Qualifications
- Experience obtaining authorizations and referrals
- Medical office experience
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