Referral Specialist - Clarkston Medical Group

Referrals Specialist

The referrals specialist is responsible for referral operations, establishing and standardizing systems and procedures for the distribution and use of health information throughout the organization, coordinating and referral functions with all other departments.

Duties and responsibilities

• Ensures current and standardized referral policies and workflows.
• Prioritizes referrals by their urgency and addresses them in a timely manner.
• Participates in the selection, orientation and training of referral personnel.
• Ensures complete demographic, insurance information and appropriate/pertaining clinical information is sent to referred specialists.
• Contacts insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as, history, diagnosis and prognosis to insurance companies if deemed necessary to prove medical necessity of services.
• Reviews details and expectations about the referral with both ordering providers and patients. Requests new referrals to be ordered when applicable.
• Develops and implements systems as required by EMR functionality and/or regulatory agencies.
• Identifies and utilizes community resources; establishes relationships with servicing providers and personnel.
• Point of contact for patients and specialists for any questions or rising concerns.
• Performs other related duties as assigned

Qualifications

• High School Diploma or GED
• 2+ years' experience in handling referrals in a licensed medical facility
• Exceptional organizational skills
• ICD-10-CM coding capabilities
• Proficient in information management programs and MS Office
• Excellent interpersonal and organizational skills
• Strong attention to detail
• Outstanding communication and interpersonal abilities
• Proficient in computer programs, including Microsoft Office and Outlook
• Knowledge of medical terminology