Referral Specialist

Metro Health | Grand Rapids, MI

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Posted Date 11/01/2019

Referral Specialist - Ear, Nose, and Throat * Days - 40hrs/wk.

Requisition #: req1886

Shift: Days

FTE status: 1

On-call: No

Weekends: No

General Summary:
To manage the flow of information related to referrals. This will include, but not limited to, documentation, tracking, pre-authorizations, certifications and follow-ups, related to all insurance type referrals. This person works closely with physicians, nursing staff and other clerical staff.


  1. Minimum 2 years experience or training in medical office or similar setting and/or prior referral experience.
  2. High School education or equivalent
  3. Medical terminology required
  4. Able to work independently and collaboratively with minimal supervision
  5. Possess knowledge of medical records content and sequence
  6. Training or experiences in ICD-9 CM coding and managed care insurance plans
  7. Possess knowledge of appointment scheduling process
  8. Must process work with minimal errors within appropriate deadlines and timeframes
  9. Possess a high level of interpersonal skills
  10. Communicate effectively, both verbal and written
  11. Able to prioritize, maintain accurate records, and work under deadline situations
  12. Demonstrates a professional manner when representing BHC
  13. Excellent customer service skills
Essential Functions and Responsibilities:
  1. Schedules and coordinates specialist appointments, procedures and tests done internally or externally.
    1. Provide accurate documentation and record keeping on referrals, authorizations, and boardings.
    2. Relay and/or review referral information in a timely fashion with appropriate clinical areas, physicians, physician office and patients.
    3. Monitor guidelines for authorizations and referrals according to payer requirements.
    4. Monitor “in network” referrals.
    5. Ensures proper insurance authorizations are processed within 48 hours.
    6. Ensure the physician provides necessary medical and patient information to referral specialist prior to patient referral.
    7. Monitor EPIC orders to ensure provider has entered information correctly.
    8. Work closely with central scheduling, pre-reg and O/P for coordination of services.
    9. Communicate and collaborate with other members of the health care team to ensure continuity and coordination of services.
    10. Interacts with providers when determining referral alternatives.
    11. Provides ICD-9 CPT coding on referrals, as needed.
  2. Provides information to internal and external customers promoting good public relations and interdepartmental relations.
    1. Demonstrate a willingness to promptly meet identified needs in a pleasant and courteous manner.
    2. Educate physician and staff, when necessary.
    3. Identify and address referral issues as they arise.
  3. Manage incoming phone calls, performs associated functions and follow up.
    1. Answer telephone in a timely manner.
    2. Maintain appropriate notes for referrals, phone calls and documents in EPIC.
    3. Respond to messages left on referral queue line.
    4. Use good telephone etiquette when answering phones, identifying self by name, title, and area.
  4. Participate and work effectively as a team member ensuring continuity and coordination of services.
    1. Attend and participate in all mandatory meetings, in-services, and staff meetings.
    2. Complete required Corporate Compliance / HIPAA education.
    3. Is knowledgeable with hospital and departmental policies/procedures and participate in revising as requested.
    4. Make suggestions and recommendations for improvement of the referral process.
    5. Provide assistance, as needed, and performs other duties as required.
    6. Attends meeting as requested to assist with the referral process.
    7. Collaborate, communicate, and support team building.
    8. Assist areas within MHB office to maintain collaboration and team support.
    9. Work with billing office on denials.
  5. Maintains a clean, safe and functional working environment.
    1. Maintain an organized work area.
    2. Takes initiative to notify appropriate person of environmental safety issues/or repairs.
  6. Performs other duties as directed by Manager or Director of Medical Education
    1. Accept responsibilities willingly.
    2. Complete tasks within timeframes requested.
    3. Act as superuser for EPIC
  7. Customer Service
    1. Communicates effectively and positively.
    2. Maintains confidentiality/privacy at all times and HIPAA guidelines.
    3. Verbal and non-verbal communication demonstrates empathy and concern at all times.
    4. Is a role model for other team members.
    5. Treat others with dignity and respect.
    6. Maintain good public relations.
Job Type
Full time

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