Referral Specialist

Explore opportunities with Holston Medical Group , part of the Optum family of businesses. Holston Medical Group combines the personal feel of a community-based practice with the strength, resources and career opportunities of a leading national health care organization. As a multispecialty clinic offering care across northeast Tennessee and southwest Virginia, our teams deliver high-quality, value-based care that exceeds expectations while making care easier, more affordable and more accessible. Join us and discover the meaning behind Caring. Connecting. Growing together.

Pay Range: $16.00 - $22.50

General Summary:
Referral Specialists at Holston Medical Group are expected to be patient focused and team oriented individuals who ensure that provider consult orders are initiated and completed as directed. They must be organized and keep abreast of changes to insurance companies requirements for prior authorizations. The Referral Specialist is expected to be knowledgeable of medical terminology and ICD-9 coding. They are expected to research claims and communicate with insurance companies, patients and employees in physician offices. The person in this position must have excellent phone etiquette and attention to detail. The Holston Medical Group Referral Specialist is expected to be knowledgeable and kind to patients, co-workers and outside vendors alike. They should exhibit a professional attitude and provide excellent customer service.


Main Responsibilities:
• Initiate and complete consult orders as requested by physician, physician's assistant or nurse practitioner
• Coordinate with internal/external physician offices and healthcare organizations as needed to complete patient referral
• Document all referral related information in the EMR (electronic medical record)
• Complete referral forms as needed per insurance requirements
• Communicate all necessary referral information (appointment scheduling information) to patient in a timely manner
• Research claims and communicate with insurance companies, patients and employees in physician offices
• Maintain quality levels that meet or exceed customer expectations through process improvement and a team oriented approach
• Maintain confidentiality in matters relating to patients
• Other duties as assigned

Education/Experience/Knowledge:
• High School diploma or equivalent required
• 2-3 years of work experience with increased responsibility in a medical office or hospital setting
• Experience and understanding of basic medical terminology
• Experience and understanding of health insurance with increased knowledge of managed care
• Experience and understanding of ICD-9 and CPT coding
• Prefer experience with Electronic Medical Records (EMR)
• Solid understanding of scheduling efficiency and patient flow in medical practice
• Excellent phone etiquette and attention to detail
• Must have strong Customer Service Skills

Physical/Mental Demands:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential : Communication with others to exchange or express information and ideas. Ability to receive detailed information through oral communication, and to make fine distinctions in sounds. Determine the accuracy, neatness, thoroughness of the work assigned and perceive general observations. Must be able to remain in a stationary position at least 75% of the time. Extending the hands and arms in any direction. Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer. Perform a variety of duties, often changing from one task to another of a different nature. Perform with frequent interruptions and/ or distractions. Make appropriate job decisions following standard office policies and past precedents. Adjust priorities quickly as circumstances dictate. Ability to establish and maintain cooperative working relationships with co-workers and the public. Work independently and identify potentially more effective methods of work operations. Ability to interact appropriately with colleagues and patients for different purposes and different context.

Marginal: Needs to move inside or outside the office space to access file cabinets. Sedentary work that includes moving objects up to 10 pounds. Observing an area that can be seen up and down or to right or left while eyes are fixed on a given point. Ability to identify and distinguish colors. Light work that includes moving objects up to 20pounds occasionally.


Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Management reserves the right to revise the job or to require that other or different tasks be performed as assigned.


All job requirements are subject to possible revision to reflect changes in the position requirements or to reasonably accommodate individuals with disabilities.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.