Job Summary and Responsibilities

As our Referral Specialist, you will orchestrate patient access to specialized care by expertly managing all referral and authorization processes.

Every day, you will proactively obtain clearances for specialty visits, issue referrals for ancillary services (consults, imaging, labs), and secure approvals for medications, DME, home health, and other vital services.

To be successful in this role, you will demonstrate meticulous attention to detail, strong organizational skills, and clear communication to ensure seamless and efficient service delivery for our patients.

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.
Job Requirements

Required

High School Graduate General Studies and 2 years of progressively responsible related experience in a healthcare environment orHigh School GED General Studies and 2 years of progressively responsible related experience in a healthcare environment

Preferred

2 years of progressively responsible related experience in a healthcare office environment specializing in the referral process andExperience in AEHR and PPMS systemWhere 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.

Total Rewards

Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit our Total Rewards

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.