Referral Care Specialist

Referral Specialist
The Referral Specialist is responsible for processing outgoing patient referrals, including entering referral orders (with physician approval), verifying in-network referral destinations, faxing referrals with pertinent medical documentation, and documenting referral activity in the patient's electronic medical record. The Referral Specialist is also responsible for obtaining authorizations for specialist office visits, as requested, via applicable payer portals.
Supervision Received: Reports to Site Supervisor. Supervision Exercised: None.
Requires eye-hand coordination and manual dexterity sufficient to operate a computer, keyboard, telephone, and multifunction office equipment (scanner, copier, and fax). Typical Working Conditions: Standard medical office working conditions.
Provide excellent customer service (friendly, courteous, and helpful) to both our internal and external customers

• Receive referral requests from specialist offices and communicate diagnosis and referral details to the nurse/medical assistant for physician review and referral ordering.
• The physician or nurse must order Family Practice referrals, while Pediatric Referral Specialists may enter referral orders with physician approval.
• Verify appropriate specialist destination and ensure referrals are directed to in-network providers when applicable.
• Fax referrals and all pertinent supporting medical records, including clinical notes, lab results, and diagnostic imaging, to the appropriate specialist office within 72 business hours.
• Obtain authorization for specialist office visits upon request by utilizing applicable insurance provider portals (i.e., Notify patients of the specialist/provider they have been referred to for STAT referrals, and provide the specialist's office phone number so the patient may schedule their appointment.
• Answer incoming calls and review voicemail messages throughout the day to respond to patients and specialist offices regarding referral status, authorization requests, and related documentation needs.
• Maintain accurate and timely referral documentation, including recording appointment dates in the Outgoing Referral section of the patient hub, and ensuring all referral and authorization activity is completed efficiently.
• Communicate with nurses/medical assistants via internal messaging to request additional referral details and provide information for review with the physician for approval.

Performance Requirements: Knowledge of business office procedures. Skill in operating a computer and a photocopy machine. Skill in answering the telephone in a pleasant and helpful manner. Ability to sort and file materials correctly by alphabetical or numeric systems. Education: High school graduation or GED. Experience: One year of work experience, preferably in a medical office setting. Knowledge of medical terminology is desirable. Word processing and computer experience.
Alternative To Minimum Qualifications: Additional appropriate education may be substituted for one year of work experience.
PPC Offers:

• Over 30 years of serving our Southwest Florida community
• Health, dental, vision, disability and life insurances
• Free financial advising
• Paid holidays
• Reimbursement for position required certifications and/or license
• Employee Assistance Program (EAP)
• Employee Resource Assistance Program (ERAP)
• Discounted legal and document services