POSITION SUMMARY

The Referral Specialist will be responsible for processing referrals for patients to seek medical treatment outside of Community Clinic, Inc. Assist with billing duties as requested by the Billing Specialist and Billing Supervisor.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• Prepares and processes all managed care referral paperwork.
• Gathers pertinent information from Physicians, Nurse Practitioners, and Physician Assistant staff to complete referrals.
• Contacts various offices/facilities to obtain necessary information to accurately complete referral requests.
• Maintains referral records and files documentation.
• Responds to patient inquires regarding health plan referrals.
• Reviews and updates insurance member lists on a monthly basis.
• Update all status in patient's accounts
• Verifies Medicaid/non insurance coverage for patient with upcoming appointments.
• Reviews returned mail for current addresses.
• Run reports to identify delinquent insurance payments. Contacts third party payers firm claim status.
• Participants in educational activities and attends monthly/weekly meetings.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

REQUIRED SKILLS OR ABILITIES

• Requires experience and demonstrated abilities for working in a multi-cultural setting.
• Knowledge of some medical terminology.
• Ability to collaborate and interact with a diverse group of health care professionals.
• Ability to initiate and maintain working relationship.
• Have understand and knowledge of population and community of service area
• Good community skills: able to listen well, use language appropriately, and able to communicate in writing.
• Excellent customer service skills

REQUIRED KNOWLEDGE, EXPERIENCE OR LICENSURE/REGISTRATION

• High School Diploma or its equivalent, some college is preferred.
• Bilingual in Spanish and English a plus