Referral Specialist

Where You’ll Work

CHI Memorial Medical Group (Mountain Management Services), a member of CommonSpirit Health, is a leading provider of comprehensive office management services for Memorial Health Partners and affiliated physicians in Southeast Tennessee and North Georgia. Our award-winning, faith-based organization is dedicated to supporting the delivery of exceptional healthcare in the region. We are proud to be consistently recognized for excellence by organizations like U.S. News & World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and as one of the Best Places to Work in Tennessee. We are honored to be your trusted ally in health, dedicated to serving our community with compassion and excellence.

Job Summary and Responsibilities

The Referral Specialist works with patients requiring a referral for a test or to a specialist office, to ensure patient’s referral needs are fulfilled for tests and specialty service office visits.  Processes orders for tests and referrals, authorizations and pre-certifications for patients, to ensure timely reimbursements. Follows up on all test and referrals to specialist office until the documentation is received and scanned into the system for reconciliation.

Essential Key Job Responsibilities

• Gather, verify, and process orders for test, 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.
• Communicates or gives written material to patients with referral information such as date, time, and location, as well as contact information to ensure patient has resources to review if needed.
• Coordinate flow of information between medical clinic and patients insurance for referral authorization to secure a valid referral for clinic patient.
• Enter and annotate testing information and referrals, does e-referral for applicable practices for meaningful use and follows-up to make sure e-referral and or faxed referrals are received, documents communications and action into PPMS and AEHR, as appropriate.
• Maintains supply of contrasting prep for testing so that when patients are scheduled the prep can be given to the patient and the patient can be educated as to the prep. Otherwise patients are told to be at the testing site 1 ½ hours early for prep.
• Notify physician(s) and patient when test or referral is denied, or if additional information is needed.
• Develop and maintain database of referral physician offices preferred by each physician within the clinic.
• Maintains complaint resolution and solutions related to patient referrals. Calls or faxes for test and referral documents, documents in notes when attempts are made to reconcile the test or referral. Scans the documents into the system and closes the order or referral. Documents all test and referrals in PPMS and AEHR for outmigration reporting.
• Knowledge of clinic referral and scheduling processes and billing / authorization requirements.
• Knowledge of federal and state pay requirements, including Medicare, DSHS, HMO / PPO Contracts.

Job Requirements

Education :

Qualifications :