Referral Specialist

Referral Specialist

The Referral Specialist is the first connection between Intermountain and patients and is responsible to focus on establishing collaborative relationships with patients and fellow caregivers (employees) to deliver the highest level of customer/patient satisfaction. Referral Specialists are responsible for fostering relationships with patients, parents and guardians regarding the patient's care to include ensuring compliance with managed care, commercial insurance, and public insurance requirements, submitting and tracking referrals, and providing efficient patient flow and service excellence.

Posting Specifics

• Benefits Eligible: Yes
• Shift Details: Monday - Friday 8:30am to 5:00pm

Essential Functions

• Effectively identifies and resolves patient, provider, and staff requests which may include; referral processing, scheduling/registration, business/billing/payor inquiries, and medical requests.
• Uses analytical skills and technical resources to anticipate and resolve patient requests, demonstrates critical thinking and problem solving during challenging patient interactions and situations with ability to recognize and follow appropriate procedures for medical and non-medical emergencies.
• Contributes to and supports enterprise productivity and quality measures/initiatives by participating, planning, communicating, and encouraging team and individual contributions toward Intermountain Health Key Performance Indicators.
• Verifies eligibility and benefits; obtains authorizations, and tracks referrals to ensure compliance with guidelines.
• Acts as a liaison between hospitals, physicians, health plans, vendors and patients or other referral sources to submit for insurance authorization for procedures, specialist visits for patients referred by an Intermountain primary care provider
• Gathers pertinent information from insurance carriers, financial counselors and other ancillary staff to make certain of the patients' financial obligations for services provided.
• Documents appropriate and complete information within the referral shell to include authorization information, location patient referred to close the loop, coordinating with teams, providers, staff, insurance companies, patients, and other clinics.
• Follows the three-touch process, reach out to patient via MyChart, phone call and letter.
• Forwards all pertinent medical records and authorization information referred to the provider's office.

Skills

• Medical Terminology
• Computer Literacy
• Customer Service
• Electronic Medical Records (EMR)
• Data Entry
• Problem Solving
• Communication (Written/Oral)
• Detail Oriented
• Critical Thinking
• Analytical Thinking
• Interpersonal skills

Minimum Requirements

• Demonstrated experience using multiple business software applications and insurance web portals simultaneously
• Prior experience in healthcare

Preferred Requirements

• Associate or higher level degree
• One year of experience with referral services, referral processing, authorization/referral claims administration or a directly related field

Physical Requirements

• Ongoing need for employee to see and read information, labels, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions with customers that require employee to communicate as well as understand spoken information, alarms, needs, and issues quickly and accurately.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer, phone, and cable set-up and use.
• Expected to lift and utilize full range of movement to transport, pull, and push equipment. Will also work on hands and knees and bend to set-up, troubleshoot, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items.
• For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location: Nevada Central Office

Work City: Las Vegas

Work State: Nevada

Scheduled Weekly Hours: 40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$19.41 - $28.14

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.