Referral Specialist- Lead

• Through mentoring, coaching and positive reinforcement, provides leadership/direction and assists a supervisor/manager in facilitating the workflow for a team of specialty coordinators, to ensure duties are completed timely and accurately while meeting regulatory standards.
•  Orient new team members and provide orientation feedback to team member and manager
• Under the direction of a supervisor/manager, may assist with personnel duties such as orientation, training, and providing feedback for performance evaluations.
• Provide telephone and in person screening and initial contact with referral sources and potential patients.
• Coordinates the intake and referral process, determines priority needs for assessment
• Provides coordination of testing to be performed with physician, patient, facility and payer. This includes reviewing medical documents for clarity, ensuring all necessary clinical steps have been taken; works with necessary parties to obtain third-party approval
• Obtains all procedure and diagnosis codes to properly authorize/pre-certify ordered testing.
• Refers self-pay and out-of-network patients to the appropriate resource to help with payment.
• Complete pre-certification/authorization with the patient’s insurance company providing any necessary documentation.
• Document authorization/pre-certification once received along with contact information of the person spoken with.
• Contacts the patients and notifies them of the scheduled procedure and all necessary instructions.
• Actively monitor the attendance of and follow-up of referred appointments
• Monitor statistics and volume of patients testing and physician appointments
• May assist manager with other responsibilities as assigned

•     Associate’s Degree in a related field