Referral Specialist

Referral Specialist Remote position – schedule Monday to Friday, 8:00 am to 5:00 pm (hours can be flexible). Compensation $20.50 – $22.50/hour depending on experience and skills Benefits Medical, Dental, & Vision – Orchid pays monthly premiums 100% for team members and at least 50% for dependents for base medical and dental plans $1,000/year Wellness Benefit – for things that make you happy! 401(k) with company match and financial planning and wellness resources at no cost. Continuing Education / Continuing Medical Education budget for all team members Employee Assistance Program (EAP) – mental health support, financial planning, and lifestyle training opportunities at no cost. 128 hours of PTO per year, front‑loaded with tenure‑based increases 40 hours of paid inclement weather and emergency closure leave, front‑loaded annually 8 paid holidays, plus birthday off Free care at our clinics for team members and their families And more! *Team members are eligible for benefits on the first of the month following 30 days of employment. Role Overview The Referral Specialist receives and documents patient referrals and follows Orchid Health’s referral process. Working with the patient/family, primary physician, Medical Director, and Clinic Healthcare Team, the Referral Specialist coordinates all patient referrals at the request of the providers, obtains/reviews pre‑authorization/pre‑certification, and coordinates communications with physician offices, companies, third‑party payers and case managers; documenting appropriately within the medical record. Responsibilities Ensure appropriate appointments and follow‑up appointments in the clinic following referral requests/visits. Ensure documentation from specialists/offices is obtained, filed in the chart, and forwarded to companies/payers as appropriate. Perform patient registration tasks and procedures as requested and assist in the clinical area as trained and requested. Initiate all referral requests within 24‑48 hours on business days. Return all calls promptly, generally within the same day. Document all stages of the referral process within the EMR program (Athena) and communicate to the appropriate people regarding injury cases. Coordinate and schedule specialty exams within the clinic as necessary. Obtain and/or document approvals from Third‑Party Payers for payment for services as directed or indicated via protocols. Answer phone calls and act as a liaison between companies, patients, attorneys and workers’ comp insurance companies. Request any missing documentation from providers, once received and signed off by the medical director, scan appropriate information into the EMR program (Athena). Resolve pre‑certification, registration and case‑related concerns prior to a patient’s appointment. Gather pertinent information from insurance carriers, financial counselors, and other ancillary staff to ensure the patient is not financially obligated for services provided. Use the EHR (Athena) to monitor referral orders and document all referral activities in the EHR. Complete prior authorizations when needed. Complete appropriate referral forms. Consult with providers regarding specific diagnosis information, as it relates to the referral. Comply with federal, state and local regulations regarding patient confidentiality and HIPAA. Ensure that the patient’s primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health. Perform other job‑related duties, as may be assigned. Required Qualifications High school diploma or GED certificate. Minimum of 1 year relevant healthcare experience. Proficient at Excel, Word, and Outlook. Excellent communication and problem‑solving skills. Excellent interpersonal skills, empathy and tact, when dealing with insurance companies, patients and other health care facilities. Able to assume the responsibilities delegated by the Manager, to provide efficient and effective coordination of care. Willing to adapt to changing situations and circumstances. Preferred Qualifications Bilingual in Spanish. Athena experience. Knowledge of medical terminology. Work Environment While in the clinic, team members may be exposed to viruses, disease, and infection from patients and specimens in the working environment. Team members may be required to work for extended periods of time at a computer. Team members use standard office equipment, such as computers, phones, and e‑fax. Physical Demands Stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard. Frequently sit for extended periods of time. Computer work is required for remote positions. Light to moderate lifting may be required. Travel Minimum of 1–2 clinic visits per year, plus in‑person meetings and events as needed. Employment Offer Contingencies Job offers are contingent upon the successful completion of a background check and drug screening. EEO Statement It is the policy of Orchid Health to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Orchid Health will provide reasonable accommodations for qualified individuals with disabilities. #J-18808-Ljbffr