Job Description

Primary Accountability

The Referral Representative is responsible for assisting with patient referrals.

of Primary Responsibilities

1. Responsible for assisting patients with the completion of referrals including multiple service lines.
   1. Coordinates and communicates with various insurance carriers to obtain necessary pre-authorizations for patients to receive needed specialty services.
   2. Appropriately verifies patient eligibility to determine the best options for specialty access.
   3. Coordinates, communicates and schedules patient appointments with external and internal specialists and provides communication to the patients regarding the process and referral status.
   4. Ensures proper use of CPT and current ICD-10 codes to meet the requirements of third party payers and specialty offices to ensure minimal delay in securing referral appointments or pre-authorizations.
   5. Prepares comprehensive referral packet, including referral order, pre-authorization paperwork, patient demographics, eligibility verification, primary care provider notes, diagnostics and/or lab work pertinent to the specialty referral.
   6. Submits required referral packet and documentation to the specialist to ensure timely processing of the referral.
   7. Ensures the efficient and timely processing of open referrals, including facilitating missing information, and that all referrals are appropriately closed and communicated to provider team.
   8. Addresses incoming calls and questions from patients and specialists regarding referral orders, care coordination and ensures the appropriate follow up is completed.
   9. Coordinates surgeries with designated hospitals, specialists and patients. Obtains hospital pre-admission from the various health insurances and health plans.
   10. Responsible for submitting referral activity reports to supervisor.
2. Responsible for utilizing the electronic health record system to obtain and document necessary information.
   1. Monitors assigned worklist throughout the day to capture referral requests in real time and organize workload based on acuity.
   2. Documents all referral processing activity, including interactions with patients, providers and specialists.
   3. Utilizes third party payer/insurance portals appropriately to ensure adequate processing of referral orders.
   4. Follows-up on completion of the entire referral process, including closing referrals.
   5. Provides orientation on the referral process to new providers and periodic in-services to existing providers and staff regarding referral process.
   6. Assists with process analysis feedback to streamline internal referral processes.
   7. Achieves specific referral productivity metrics.
3. Performs other duties as assigned.

of Primary Attributes

Professional & Technical Knowledge:

1. Possesses work-related skills at a higher level than completion of high school, including formal written and verbal communications skills, computational and computer skills, mathematical, technical or health care related knowledge frequently acquired through completion of a trade school, para-professional, or certificate type program or at least 1 year of experience with employment in a medical office.

Technical Skills:

1. Ability to prepare more complex documents in Microsoft Word, including creating tables, charts, graphs and other elements.
2. Ability to use Microsoft Excel to review and compile data, including the use of formulas, functions, lookup tables and other standard spreadsheet elements.
3. Ability to create basic presentations in Microsoft PowerPoint.

Licenses & Certifications: Medical Assistant certification preferred.

Communications Skills:

1. Job duties require the compilation of information prepared in effective written form, including correspondence, reports, articles or other documentation.
2. Effectively conveys technical information to non-technical audiences.

Physical Demands: The physical demands described here in this job description are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this position, the employee is regularly required to sit and use repetitive hand movement to type and grasp. The employee is frequently required to stand or walk; and occasionally lift and/or move up to 20 pounds.

Pay Scale:

Min Hourly Rate: $21.00

Max Hourly Rate: $28.60