Referral Specialist

Company: Common Spirit
Location: Lexington
Posted on: June 24, 2022

Job Description:

Overview

Saint Joseph East is a 217-bed full-service community hospital located in the rapidly growing southeastern section of Lexington Kentucky. We provide care for patients in Fayette and surrounding counties. At Saint Joseph East ambulatory surgery 24-hour emergency care and women's health services are supported through a vast array of inpatient and outpatient program. Additional specialty services include Heart Care Breast Care Sleep Care and Weight Loss Surgery. CHI Saint Joseph Health supports 5000 active employees 8 hospitals specialty clinics and a Medical Group with more than 200 locations across Central and Eastern KY. CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health in 2019. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

Responsibilities

Job Summary

The Referral Specialist works with patients requiring a referral, to ensure patient's referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.

Key Responsibilities

* Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
* Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.
* Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
* Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patient.
* Enter referrals, documents communications and action into the system, as appropriate.
* Notify physician(s) and patient when referral is denied, or if additional information is needed.
* Develop and maintain database of referral physician offices preferred by each physician within the clinic.
* Assist Practice Manager with complaint resolution and solutions related to patient referrals.
* Perform other duties as assigned by the practice manager or physician.

Qualifications

Job Requirements

Education- High school diploma or equivalent

Experience (required and preferred)- 2 years of progressively responsible related experience in a healthcare environment required.

Keywords: Common Spirit, Lexington , Referral Specialist, Other , Lexington, Kentucky