Referral Specialist I
Core
Facilitate administrative components of clinical referrals and manage appeals for a clinical team.
Role type
Administrative Referral Specialist
Builds
Clinical referral workflows and appeal resolution processes
Domain
Healthcare administration / Insurance claims
Deliverable
client delivery
Required skills
Multi-tasking, verbal communication, written communication, detail orientation, critical thinking, problem-solving, digital tool proficiency
Preferred skills
Medical terminology knowledge, prior healthcare experience
Responsibilities
Validate appeal requests and initiate/manage clinical referrals for pre-authorization; manage appeals live line, voicemails, and emails; triage and review referral mail for completeness; open and close appeal requests per established processes; verify insurance coverage and complete pre-authorization for imaging exams; respond to inbound exam requests; contact physician offices for demographic data; enter referrals and document communications in systems.
Seniority
Entry-level, non-management