Job Details

Referral Specialist

The Referral Specialist is responsible for scheduling referrals for patients, providers, pre-authorizing & pre-certing tests/procedures. Scheduling of other tests with facilities at the request of providers and/or staff. Directly communicates with the clinics, referred to clinics, and patients. Reviews clinical data to report medical necessity to insurance companies. Performs all work in accordance with the mission, vision, and values of the practice.

Qualifications:

• Education: High school graduate or GED required.
• Work experience: Minimum of two years' experience in a healthcare or clinical setting.
• Knowledge: Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, and federal and state insurance Regulations and HIPAA privacy standards is strongly preferred.
• Typing, 10-key, and computer skills required. Proficiency in Microsoft Office applications required.
• Required effective interpersonal skills and excellent written, oral communication skills.
• Acute healthcare knowledge and ability to evaluate clinical data to acquire pre-authorizations and referrals are preferred.
• Knowledge of third-party reimbursement regulations is preferred. Patient Management, Billing, and Managed Care system processes competency.
• Understanding of functions and workflow of Clinical/Hospital departments.
• Excellent planning and organizational skills. Demonstration of strong analytical skills and problem-solving abilities.
• Strong teamwork skills and the ability to effectively communicate with all management levels.
• Results-oriented, independently goal-directed, able to multitask and meet established time frames.
• Excellent customer service skills and must be able to work independently.

EEO Statement: All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.