Referral Specialist

Job Description:

The Referral Representative processes insurance pre-authorization for primary and specialty service office visits and testing. Receives and gathers pertinent information from patients, providers, insurance carriers, and other staff to confirm the patient’s financial obligations for services. Acts as liaison between clinical staff, health plans, providers and patients to obtain insurance authorizations acting as the patient advocate in this circumstance. Verifies insurance coverage and obtains required authorization when necessary. Documents referral information, communications, actions and other data in electronic medical information systems to communicate to other staff a patient’s authorization progress.

Posting Specifics

• Benefits Eligible: Yes
• Shift Details: Monday - Friday, business hours

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, Massachusetts, Minnesota, New York, Pennsylvania, Rhode Island, Vermont, Virginia and Washington.

 

Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings. 

Essential Functions

• Administrative departmental support, including processing into and through electronic medical records internal, external, and outbound referrals while assembling, researching, and triaging information about patient demographics, insurance, and medical needs. Maintains ongoing tracking and appropriate detailed documentation of referrals to promote team awareness and ensure patient safety. 
• Follows regulatory requirements as defined by provider or specialty department to route inbound referral appropriately. Including appropriate documentation, imaging, or any other requirements while maintaining Intermountain standards for adding and scanning required information into electronic medical records. 
• Liaison between patient, clinic, and insurance carrier to set details related to upcoming visit with Intermountain providers or scheduled procedures prior authorization requirements. Coordinates provider peer to peer interactions as it pertains to obtaining insurance approvals. Generates cost estimates for services as it relates to office visits and in-office testing; directs patients to financial counseling resources when appropriate.  
• Contacts insurance company representatives or their contracted review organizations to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis, and prognosis. Assumes the advocate role on the patient’s behalf with the insurance carrier to ensure approval of necessary services for the patient in a timely fashion.  
• Multiple partnerships with Patient Service Representatives and Clinical Staff for effective pre-registration and pre-visit preparation as needed. Also collaborates with Payer Relations to provide the required documentation relating to any denial or appeal information needed. All other duties as needed 
• Utilization of different insurance platforms and medical records systems according to department protocols to include accurate data entry and retrieval of information for reporting purposes.  
•  Meets performance standards, volume metrics while aligning with mission, vision, and values.  

Skills

• Detail-Oriented
• Medical Terminology
• Customer Service
• Medical Records Management
• Critical Thinking
• Researching
• Communication
• Documenting

Minimum Qualifications

• Have a level of computer literacy that ensures accuracy and timeliness.
• Demonstrated ability to work well with coworkers and patients.
• Ability to collaborate with multiple teams.
• Skill to write clearly and professionally.
• Be thorough, precise and detail oriented.
• Knowledgeable in navigating Microsoft systems (Word, Outlook, Excel, OneNote).

Preferred Qualifications

• Experience with electronic medical records (EPIC).
• CNA, MA, EMT or healthcare or health plan experience.
• Referral coordination experience.
• Medical terminology knowledge.
• Bilingual (Spanish preferred)

Physical Requirements

• Ongoing need for employee to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies.
• Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, medication preparation, etc.
• Expected to lift and utilize full range of movement to transfer patients. Will also bend to retrieve, lift, and carry supplies and equipment. Typically includes items of varying weights, up to and including heavy items.
• Need to walk and assist with transporting/ambulating patients and obtaining and distributing supplies and equipment. This includes pushing/pulling gurneys and portable equipment, including heavy items. Often required to navigate crowded and busy rooms (full of equipment, power cords on the floor, etc.)
• May be expected to stand in a stationary position for an extended period of time.
• For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location:

Intermountain Health Lutheran Hospital

Work City:

Wheat Ridge

Work State:

Colorado

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience. 

$19.41 - $28.14

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.

Computer literacy, collaboration, clear writing, attention to detail, Microsoft systems proficiency; preferred experience with EPIC, CNA/MA/EMT or healthcare experience, referral coordination, medical terminology, bilingual Spanish.

Key Responsibilities

• processing insurance authorizations
• verifying insurance coverage
• documenting referral information

Skills & Tools

Microsoft Word, Microsoft Outlook, Microsoft Excel, Microsoft OneNote, EPIC

Job Details

• Category: Healthcare Services - Allied Health
• Seniority: No Prior Experience Required
• Commitment: Full Time
• Workplace: Remote — Wheat Ridge or California or Connecticut or Hawaii or Illinois or Massachusetts or Minnesota or New York or Pennsylvania or Rhode Island or Vermont or Virginia or Washington
• Salary: USD 40,372 – 58,531 / year
• Languages: English

About Intermountain Health

A nonprofit health system with hospitals and clinics across the western United States, focused on clinical quality improvement and efficient healthcare delivery. — Industry: Healthcare