Medical Referral Specialists

Key Responsibilities

• Obtains and processes referrals from providers and communicates authorizations with patients (via phone & mail) and medical staff in a timely manner.
• Prepares, processes, and completes referrals accurately and in a timely manner, including urgent and stat referrals for assigned members.
• Tracks referrals in the electronic medical records (EMR) system; Follows up on submitted authorization requests and maintains consistent status updates via EMR.
• Monitors and reports on status of authorization requests; escalates issues as necessary until fully resolved and the referral loop is closed.
• Communicates referral and authorization information and pertinent medical information to the patient and specialty providers.
• Manages the need for redirection across all clients and payers by working with clinical teams to ensure the timeliness of re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care.
• Reviews consultation reports for needed follow-up requests and works with providers to ensure timely processing of all follow-ups.
• Works with the health information (medical records) department to ensure timely retrieval of consultation reports.
• Assists the patient with scheduling appointments with the specialist, should the patient express any challenges in accomplishing this themselves.
• Submits retro-authorizations and distinguishes between primary care and internal specialty visits.

Skills, Knowledge and Expertise

• Minimum of 6 months experience in the US healthcare industry required.
• Strong understanding of US medical billing, collections, coding, and healthcare regulations is a plus.
• Experience with ICD-10 and CPT code assignment is an advantage.
• Excellent written and verbal communication skills.
• Computer literate, in encoding, and word-processing