Referral Processing Specialist
Core
Verify referral information for home care patients, triage incoming referrals, and process insurance eligibility to facilitate patient access to home health services.
Role type
operational referral processing specialist
Builds
patient intake workflows and insurance verification records
Domain
home health care / medical administration
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
triaging referrals, assembling EMR data, verifying insurance coverage, identifying patient costs, determining payer eligibility, coordinating transfer of care, maintaining office supplies, monitoring reports, communicating with referral sources and clinical staff, using telephony systems, utilizing Microsoft Office
Preferred skills
call center experience, knowledge of medical terminology, familiarity with Medicare/Medicaid procedures
Technologies
EMR systems, telephony systems, Microsoft Office (Word, Excel)
Responsibilities
triage home health referrals from telephonic, electronic, or fax sources; assemble referral data in electronic medical records; verify insurance coverage and patient out-of-pocket costs; screen and route phone calls from referral sources; order and maintain office supplies; monitor and follow up on pending patient reports; coordinate transfer of care documentation with clinical and non-clinical staff; adhere to standardized workflows for referral processing; visit referral sources to build relationships and promote communication.
Seniority
entry-level to mid-level individual contributor