The Referral Specialist receives, analyzes, and processes all patient referrals and authorization requests according to insurance requirements, ensuring patients are cleared for specialty services and procedures. This role involves coordinating patient care to specialists, verifying insurance, obtaining prior authorizations, and working closely with Coding and Insurance Verification Teams.
Requirements summary
Candidates must possess an Associate’s degree or equivalent, along with 2 years of experience in a medical setting, or an equivalent combination of education and experience. Required knowledge includes electronic health records, ICD-10 and CPT coding, insurance billing rules, and strong skills in communication, data entry, and time management.
The Referral Specialist is responsible for receiving, analyzing and processing all referrals and authorization requests for patients according to specific insurance requirements.
The Referral Specialist ensures patients have been cleared for specialty service office visits and certain procedures.
The Referral Specialist will provide support to clinical staff in order to facilitate the administrative components of clinical referrals for various services and work closely with the Coding Team to ensure billing codes are accurate on all referrals and work with the Insurance Verification Team to ensure accurate and verified insurance prior to submitting the referral and/or prior authorization.
Coordinate patient care to specialists.
Verifying patient insurance and confirming patient benefits.
Obtain prior authorizations.
Health, Wellness & Retirement Benefits
Medical, Dental & Vision insurance
Paid time off & paid holidays
Retirement with contribution match
Life & AD&D, pet insurance
Employee assistance program, & more!
Compensation
The wage range for this position is $23.25 per hour to $29.23 per hour.
Final offers are individually based on various factors, including skill set, years of experience, location, qualifications, work schedule and other job-related reasons.
Union: SEIU Healthcare 1199NW
Primary Responsibilities
Processes physician referral orders (EKG’s, CT, MRI, etc.) using EHR system. This includes obtaining any authorization needed.
Accurately enters notes into EHR regarding letters or correspondence from insurance companies regarding insurance authorization or other referral notifications.
Demonstrates and applies knowledge of medical terminology.
Communicates the results of the authorization request with the patient.
Processes physician referral orders (EMG, CT, MRI, etc.) using EHR system. This includes obtaining any authorization needed in a timely manner.
Benefits
Medical
Dental
Vision insurance
Paid holidays
Paid time off
Employee assistance program
Pet insurance
Life & AD&D
Retirement with contribution match
Applies knowledge ICD-10 and CPT coding.
Answering incoming patient and insurance company phone calls as received.
Maintains up-to-date knowledge of insurance plans and billing rules.
Perform other duties as assigned within job qualifications.
Required Skills
Working knowledge of electronic health record systems.
Knowledge of ICD-10 and CPT coding.
Knowledge and ability to work effectively with a team and with patients.
Knowledge of and skill in the use of personal computers with the ability to learn and use company software programs including practice management systems as well as spreadsheets, and word processing applications.
Knowledge of billing rules for government and third-party payers.
Skill in time management.
Skill and proficient in data entry.
Demonstrated ability to understand the clinical content of a health record.
Demonstrated skill and ability to effectively communicate in writing and orally with the ability to present, explain, and write information in a clear, concise, and organized format.
Ability to effectively work with a variety of healthcare professionals at all levels.
Education/Experience Requirements
Associate’s degree (AA) or equivalent from a two-year college or technical school.
2-year’s experience in a medical setting; or equivalent combination of education and experience.
About Neighborcare Health
Since 1968, Neighborcare Health has been removing barriers to health care for our neighbors. We believe everyone deserves a place to call their health care home, where a team of medical, dental and mental health professionals work in collaboration with each patient to develop a personal health improvement plan.
We are one of the largest providers of primary medical, dental and behavioral health care services in the Seattle area serving low-income and uninsured families and individuals, seniors on fixed incomes, immigrants, and people experiencing homelessness. Each year we care for nearly 60,000 patients at our nearly 30 non-profit medical, dental and school-based clinics. We ask everyone to pay what they can, but no one is turned away due to inability to pay.
Our clinics are located in neighborhoods where health disparities are the greatest, and our care teams, who speak over 55 languages and dialects, are as diverse as our patients. No matter who you are, or where you come from, regardless of your insurance, income or immigration status, you are welcome at Neighborcare Health.
