Referral Representative

Overview

JOB SUMMARY: 

Under general supervision, exercise independent judgment to obtain referral authorizations and pre-certifications for physician services, ancillary services, and other related medical, therapeutic and diagnostic services. Responsible for coordinating appointments for clinic visits, appointments for tests and procedures, and coordinating treatment with other departments and institutions. 

EDUCATION/EXPERIENCE: 

High school diploma or GED equivalent with two years' office or clerical experience required. Experience in a healthcare or medical environment with knowledge of medical terminology and various insurance plans preferred. Medical terminology as required by department to be served. 

ESSENTIAL FUNCTIONS: 

1. Reviews insurance plans for referral requirements. Obtains referral authorizations or pre-certifications from the insurance plans by contacting the carrier. 

2. Schedules appointments in other areas of the Medical Center for x-rays and various lab work. 

3. Contacts specialist clinics to obtain appointments for patients. Follows physician or nurse directions as to the timeframe in which patient should be seen. 

4. Coordinates appointments for clinic patients with physicians outside of the Medical Center as directed by attending physician and as required by the patient's insurance carrier. 

5. Coordinates testing for patients, using judgment and discretion as to the seriousness of condition to properly plan for timeframe of tests and types of tests performed. 

6. Provides special instructions related to clinic appointments, tests, or procedures. 

7. Performs other related duties incidental to work described herein. 

SKILLS/QUALIFICATIONS: 

Excellent oral and written communication skills Knowledge of medical terminology Computer skills including keyboard and mouse functions, e-mail, and Microsoft Data entry accuracy of 5000 kph with 3% or less error rate 

WORK ENVIRONMENT: 

Medical office/clinic