Referral Specialist - Delta Health Orthopedics

About the position

The Referral Specialist at Delta Health Orthopedics plays a crucial role in processing referrals for specialty service office visits, ensuring that all medical records activities are handled confidentially and efficiently. This position serves as a liaison between patients, healthcare providers, and insurance carriers, facilitating communication and coordination of care. The Referral Specialist is responsible for maintaining accurate health records, verifying insurance coverage, and ensuring that all referral information is complete and processed in a timely manner.

Responsibilities

• Gathers pertinent information from patients, insurance carriers, financial counselors, and other staff to confirm the patient's financial obligation for service.
• Acts as a liaison between hospital, clinical staff, health plans, providers, and patient to process referrals.
• Verifies insurance coverage and obtains required authorization when necessary.
• Documents referrals, communications, actions, and other data in the EMR.
• Generates and distributes all applicable forms, notifications, and paperwork.
• Assists the healthcare team in coordinating, prioritizing, and communicating patient, physician, and staff needs.
• Makes follow-up phone calls to patients regarding outstanding labs, procedures, and scheduling referrals.
• Communicates with providers to correct any referral changes.
• Performs other duties or projects as determined by the manager.
• Responsible for clerical functions within the clinic, including answering telephones, patient reminders, assisting visitors and family members, collection of payments, and scanning, organizing, and uploading documents into the EHR.
• Prepares medical records files for release or transfer to providers, patients, insurance companies, and attorneys according to HIPAA compliance policies.
• Maintains day-to-day scheduling of patient appointments.
• Extracts old records from EHR systems and adds items to Athena Health.
• Pulls health information from QHN and enters data as structured data or formal documents.
• Acts as a fiduciary of the organization, adhering to duties of loyalty, care, good faith, fair dealing, and disclosure of material information.

Requirements

• High school diploma or GED required.
• 2+ years of healthcare experience required.
• Health plan, billing and coding, and authorization intake experience preferred.
• Excellent written and verbal communication skills.
• Ability to manage multiple patients at once throughout different approval processes.
• Extensive knowledge of healthcare plans such as Medicare.

Nice-to-haves

• Experience with Athena Health software.
• Knowledge of HIPAA compliance regulations.

Benefits

• Medical, RX, Dental, Vision coverage.
• Retirement plan with up to a 3% match.
• Paid Time Off (PTO) including 4+ weeks of vacation, sick pay, and personal time off.
• Scholarships towards continued education.
• Employer paid Life and Disability coverage.