Referral Specialist - Georgetown Clinic (1.0 FTE)

The Referral Specialist is responsible for receiving, analyzing and processing all referrals and authorization requests for patients according to specific insurance requirements. The Referral Specialist ensures patients have been cleared for specialty service office visits and certain procedures. The Referral Specialist will provide support to clinical staff in order to facilitate the administrative components of clinical referrals for various services and work closely with the Coding Team to ensure billing codes are accurate on all referrals and work with the Insurance Verification Team to ensure accurate and verified insurance prior to submitting the referral and/or prior authorization.  Coordinate patient care to specialists. Verifying patient insurance and confirming patient benefits. Obtain prior authorizations.

• →Processes physician referral orders (EKG’s, CT, MRI, etc.) using EHR system. This includes obtaining any authorization needed.
• →Accurately enters notes into EHR regarding letters or correspondence from insurance companies regarding insurance authorization or other referral notifications.
• →Demonstrates and applies knowledge of medical terminology.
• →Communicates the results of the authorization request with the patient.
• →Processes physician referral orders (EMG, CT, MRI, etc.) using EHR system. This includes obtaining any authorization needed in a timely manner.
• →Applies knowledge ICD-10 and CPT coding.
• →Answering incoming patient and insurance company phone calls as received.
• →Maintains up-to-date knowledge of insurance plans and billing rules.
• →Perform other duties as assigned within job qualifications.

• Working knowledge of electronic health record systems.
• Knowledge of ICD-10 and CPT coding.
• Knowledge and ability to work effectively with a team and with patients.
• Knowledge of and skill in the use of personal computers with the ability to learn and use company software programs including practice management systems as well as spreadsheets, and word processing applications.
• Knowledge of billing rules for government and third-party payers.
• Skill in time management.
• Skill and proficient in data entry.
• Demonstrated ability to understand the clinical content of a health record.
• Demonstrated skill and ability to effectively communicate in writing and orally with the ability to present, explain, and write information in a clear, concise, and organized format.
• Ability to effectively work with a variety of healthcare professionals at all levels.

• Associate’s degree (AA) or equivalent from a two-year college or technical school.
• 2-year’s experience in a medical setting; or equivalent combination of education and experience.

Full job description is available upon request.