Healthcare Referral/Prior Authorization Specialist

Holston Medical Group 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. 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.
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
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

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer. Make appropriate job decisions following standard office policies and past precedents. Work independently and identify potentially more effective methods of work operations. Needs to move inside or outside the office space to access file cabinets. All job requirements are subject to possible revision to reflect changes in the position requirements or to reasonably accommodate individuals with disabilities.