Referral Specialist II
Core
Facilitate administrative components of clinical referrals by acting as a liaison between hospitals, health plans, physicians, patients, and vendors.
Role type
Clinical Referral Specialist
Builds
Clinical referral workflows and patient care pathways
Domain
Healthcare administration / Insurance operations
Deliverable
client delivery
Required skills
Medical terminology, ICD-9 and CPT coding, Insurance verification, Authorization processing, Data entry, Multi-tasking in high-volume environments
Preferred skills
Knowledge of plan-specific guidelines, Experience in high-volume customer service or call centers
Responsibilities
Review complex referrals for completeness, Assign referrals to staff, Verify insurance coverage and obtain authorizations, Contact physician offices for demographic data, Document communications and actions in system
Seniority
Entry-level, Non-Management