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Referral Specialist Facility: MCMG Administration Location: ,

Referral Specialist Facility: MCMG Administration Location: ,

Job Description

  • High School Diploma/GED
  • Referral Specialist
    We are seeking highly motivated Referral Specialists to join our team and work in a dynamic work environment that is team oriented, professional, customer friendly and devoted to excellence.
    Opportunities available at our following locations:
    • MCMG Administration-Columbus, OH

    Job Description:
    The Referral Specialist coordinates, maintains, confirms and/or secures referrals, authorizations, or precertifications needed on physician/clinic services. Verifies the accuracy and completeness of admitting information on outpatient referrals and obtains authorizations when needed. Also maintains and keeps updated referral logs.

Job Requirements

High School diploma or equivalent required. One year of experience in a similar position in a medical office preferred. Knowledge of medical terminology and medical office procedures preferred.  Knowledge of third party payers and pre-authorization requirements preferred. Basic computer skills required.  Must be able to work as a member of a team along with effective communication skills.
 Job Duties Include:
•         Contacts insurance carriers after verifying information to secure benefit coverage, policy
      limitations, pre-certification, etc. for customers.

•         Conducts follow-up calls as necessary to physician offices, patients, and third party payers
      to complete pre-certification process.

•         Contacts relevant internal staff to update status, coordinate resolution/correction of issues,
      sends records to insurance companies and determines whether a denied authorization
      should be appealed.

•         Educates internal and external customers regarding referral/prior authorization
      requirements, eligibility guidelines, documentation requirements, and insurance procedures.

•         Maintains reference materials as they pertain to insurance carrier procedures.

•         Maintains referral tracking logs and ensures that they are kept up to date.

•         Maintains patient confidentiality and abides by all HIPPA guidelines.

•         Schedules outside testing and appointments

•         Schedules appointments, procedures, and testing as needed.

•         Responsible for compliance with Organizational Integrity through raising questions and
      promptly reporting actual or potential wrongdoing.

Job Snapshot

Employment Type Full-Time
Job Type Health Care
Education High School
Experience Not Specified
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
Job ID 90013212
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Referral Specialist Facility: MCMG Administration Location: ,

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