Referral Specialist

Description

Wage Range: $23.25 - $37.20 per hour

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

Job Summary:

Responsible for the coordination and administrative requirements for patient referral from a primary care provider (PCP) to specialists or specialty services, dealing directly with health plans. Makes decisions and authorizes risk planning referrals, utilizing department and organizational guidelines. Requires daily interaction with patients, staff, healthcare providers and insurance companies.

Primary Duties:

1. Demonstrates mastery of all Patient Service Representative duties.
2. Processes patient referrals from PCP to specialist, working directly with health plans, troubleshooting when necessary.
3. Serves as a point person coordinating information regarding managed care referrals for patients, providers, case managers and other Utilization Management staff.
4. Assigns proper ICD-10 and CPT code(s) to patient referrals.
5. Responsible for communication and dissemination of key managed care contractual information and system processes to patients and staff.
6. Identifies and communicates changes in insurance requirements, provider changes and guidelines to leaders and team members.
7. Performs other duties as assigned

License, Certification, Education or Experience:

REQUIRED for the position:

o Associate degree or equivalent combination of education and experience
o 2 years of experience in a healthcare insurance or related medical office setting
o Working knowledge of ICD-10 and CPT codes
o Ability to be flexible and relate well with others in a professional and pleasant manner
o Knowledge of medical records confidentiality
o Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians, and hospital staff members

DESIRED for the position:

o Medical Terminology, medical billing, and computer skills
o Working knowledge of insurances, Medicare, DSHS, Labor and Industries, and other third-party insurances

Benefit Information:

Choices that care for you and your family

At EvergreenHealth, we appreciate our employees' commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

• Medical, vision and dental insurance
• On-demand virtual health care
• Health Savings Account
• Flexible Spending Account
• Life and disability insurance
• Retirement plans (457(b) and 401(a) with employer contribution)
• Tuition assistance for undergraduate and graduate degrees
• Federal Public Service Loan Forgiveness program
• Paid Time Off/Vacation
• Extended Illness Bank/Sick Leave
• Paid holidays
• Voluntary hospital indemnity insurance
• Voluntary identity theft protection
• Voluntary legal insurance
• Pay in lieu of benefits premium program
• Free parking
• Commuter benefits

View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.

EvergreenHealth Benefits Guide