Referral Job Description

Referral Job Description

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Referral provides assistance to TSPMG providers and office staff on coding and targeted review questions.

Referral Duties & Responsibilities

To write an effective referral job description, begin by listing detailed duties, responsibilities and expectations. We have included referral job description templates that you can modify and use.

Sample responsibilities for this position include:

Bachelor’s degree preferred or equivalent work experience is considered
Answer incoming phone call from patients to schedule appointments with employed physician practices
Schedule appointments accurately according to the reference documentation for each physician.*
Answer incoming phone calls from consumers to provide physician referral, class/program registration, community service referral or appointment scheduling
Provide accurate computer documentation of all telephone encounters
Outbound calls for member communications, satisfaction surveys, appointment reminders or other calls as needed.*
Maintain physician referral and class/program/service referral information into database.*
Update/maintain on regularly scheduled basis.*
Assist with additional product-specific projects as needed.*
Process health plan specific referral requirements including prior authorizations

Referral Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Referral

List any licenses or certifications required by the position: MA, BLS, CPR, EMT, NIHSS

Education for Referral

Typically a job would require a certain level of education.

Employers hiring for the referral job most commonly would prefer for their future employee to have a relevant degree such as Associate and Bachelor's Degree in Education, Associates, Medical, Business, Healthcare, Medical Terminology, General Education, Graduate, Social Work, Health Care

Skills for Referral

Desired skills for referral include:

Medical terminology
Multiple brands
Financial services industry
Products and solutions
Banking products and services
Windows based computer environment
ICD 10 and CPT coding
Insurance authorization process
Insurance plans and educate providers and staff
Coding and medical terminology

Desired experience for referral includes:

Manage medical/legal communications, scheduling of depositions and attorney conferences
Safety liaison
Position is cross trained in Reception duties
Front desk and medical secretary coverage
Identify the DVMs that do not refer business but should be (based on geography)
Schedule and manage hospital hosting and hospital participating events

Referral Examples

1

Referral Job Description

Job Description Example
Our company is looking to fill the role of referral. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for referral
  • Assist Patient Services Representatives with all related duties
  • Works with the Chief Medical Officer to update standing orders as needed
  • Office visit and testing referrals and authorizations
  • VIR procedure authorizations and appeals
  • Vascular Surgery testing and procedure/surgery authorizations
  • Insurance verification for daily OV in Sorian
  • Answering phones and routing appropriately
  • Work closely with the Admitting and HVIS department to insure all proper authorizations are received prior to procedures
  • Provide coverage for check in/ checkout for department as needed
  • Discuss insurance questions with patients and help resolve issues
Qualifications for referral
  • Strong experience working in a DevOps orientated software development organization that is focused on automation of platforms continuous integration and deployment
  • Experience with building container based virtual environments (Docker, Marathon, Mesos, Kuberenetes) is a plus
  • Proficient in operating and managing clusters than span across multiple data centers
  • Experience using source control systems such as GIT, Subversion or Perforce
  • Experience with Jenkins, Artifactory, Puppet, Ansible and other CI tools
  • Experience with logging and monitoring tools (ELK, Splunk, Nagios)
2

Referral Job Description

Job Description Example
Our innovative and growing company is hiring for a referral. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for referral
  • Represent the first line of communication with physicians and the office staff
  • Receive all pertinent referral information and forward requests to the insurance plan through different electronic mediums (fax, web-based applications and telephone) as indicated
  • Be required to review referrals for basic elements and refer to appropriate staff
  • Assemble information concerning patient’s clinical background and referral needs
  • Per referral guidelines, provide appropriate clinical information to specialist
  • Present necessary medical information such as history, diagnosis and prognosis
  • Review details and expectations about the referral with patient
  • This position is cross trained and will be responsible for Patient Registration/Scheduler as part of daily responsibilities
  • Receives referral request order from the provider
  • Records referral request services with date and initials
Qualifications for referral
  • Associates degree or equivalent amount of education and experience
  • 2 years as Medical Assistant with an emphasis in Family Practice and/or Pediatrics
  • Preferred skills include previous public cloud experience with Amazon, Google, or Azure
  • Ability to look toward the future plan ahead and solve problems
  • Experience working is a healthcare setting is preferred
  • Knowledge of referral and authorization processes is required
3

Referral Job Description

Job Description Example
Our innovative and growing company is looking for a referral. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for referral
  • Forwards referral request and documentation to IPA, Health Plan, Specialist and/or Facility
  • Documents actions in patient health record and/or on referral log
  • Updates member of referral request
  • Dates and time stamp the referral approval received from the IPA or Health Plan then scans into patient’s health record day approval is received
  • If referral is urgent, notifies patient of referral request response from the patient’s IPA, Health Plan, Specialist and/or Facility by telephone
  • If routine referral, contacts patient to notify them of their referral’s approval/denial via US Mail and documents this method of notification in the health record
  • Fax the required patient health information to the specialist
  • If requested by specialist, and where appropriate, submits a request to the IPA for a follow-up referral with the specialist or for the recommended procedure
  • If the results/reports for routine referrals are not received within ten (10) business days of the referral, follows up with both the patient and authorized referring healthcare provider(to validate if the patient went to and completed the referral appointment)
  • If the results/reports for Urgent referrals are not received within five (5) business days, follow up with both the patient and authorized referral healthcare provider/ testing facility
Qualifications for referral
  • Knowledge of Sorian and Power chart applications is a plus
  • Knowledge of insurance sites like Navinet, Emdeon and private payer websites a plus
  • A working knowledge of CPT and ICD10 coding is required
  • Understanding of Workman’s Comp Insurance preferred
  • Understanding Workman’s Comp terms and processes involved preferred
  • Set new standards, create new processes, and work with cutting-edge technology
4

Referral Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of referral. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for referral
  • Maintain hospital website and social pages with timely and updated information
  • Contact primary care physicians for new and established patient referrals
  • Contact insurance companies for authorization for office visits
  • Enter case management information in to Centricity for office visits
  • Audit schedule daily for the following day
  • Follow up on orders entered daily for referrals
  • Collect and forward all clinical and insurance information to contracted facilities for DME, imaging, PT and other specialists
  • Submit and follow up on requests to PCP's/insurances for referrals/authorizations
  • Receive patient phone calls and work with them to resolve referral issues
  • Import referrals/authorizations into patients EMR
Qualifications for referral
  • Understanding of capitation, fee for service agreements co-pay and COB information
  • Ability to build effective working relationships with physicians and their staff, other QRM staff members, hospitals, vendors, and other departments
  • Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance)
  • Collect information concerning patient's clinical background and referral needs
  • Bilingual in English and Spanish—ability to read, write and speak both fluently
  • Minimum of two years’ experience working in a health care environment preferred
5

Referral Job Description

Job Description Example
Our innovative and growing company is looking for a referral. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for referral
  • Collect and verify insurance authorization requirements to ensure payer requirements are met in a timely manner
  • Effectively communicate with internal and external customers including medical providers, clinic staff, and insurance companies
  • Maintain ongoing tracking and appropriate documentation on referrals and authorizations via computer system and/or manual systems
  • Assists in pulling reports
  • Data entry of claims information into database
  • Updating and maintaining our website
  • Managing social media and developing strong marketing techniques around social media
  • Triage all incoming consult requests that come the office to ensure all paperwork and demographic information is attached and verifies that initial patient workup has been completed to NSA MD standards
  • Retrieves patient demographics, office notes, radiology reports, and relevant imaging for film review process
  • Patient liaison with referring provider offices
Qualifications for referral
  • Minimum of one year experience working with multiple insurance plans and networks
  • Experience obtaining insurance authorizations strongly preferred
  • Monitor work queues to ensure management of referrals in a timely manner
  • Provide specialists office with pertinent medical records, while maintaining confidentiality
  • Uses sound judgment when managing referrals to ensure patient safety.*
  • Manages the issues encountered when daily operational changes take place

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