Referral Specialist

A referral specialist is responsible for ensuring that patients have access to other specialty healthcare providers under their insurance. As a referral special, you are an expert in understanding various insurance plans and medical services. Furthermore, referral specialists have excellent communication skills, as they not only talk to patients but also act as a liaison between hospitals, healthcare providers, vendors, and physicians. 

Job Responsibilities

• Answer phone calls and follow regulations in processing faxes 
• Gather relevant information from insurance carriers and patients
• Confirm eligibility and benefits 
• Organize medical files and referrals 
• Enter data into an information and authorization system 
• Oversee pre-certification of procedures for insurance company approval
• Communicate with healthcare facilities, patients, and insurance providers

Skills and Qualifications 

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