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Referral Specialist

Referral Specialist
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Boscobel, WI 53805

Posted 1 month 1 week ago
Full time

Love + medicine is who we are, it's what we do, it's why people want to work here. If you’re looking for a job to love, apply today.

Scheduled Weekly Hours:


Job Description:

Responsible for timely processing, documenting, scheduling and follow up of referrals and request for treatment authorizations as requested by the primary provider.  The Referral Specialist provides superior customer service to both internal and external customers regarding insurance coverage, referral and prior authorization information and patient liability.Responsible for ensuring that all accurate and completed registration, demographic information, and insurance coverage is secured prior to services being rendered, and that all patient liability estimates and expectations are communicated and attempted.

Major Responsibilities:

  • Maintain ongoing tracking and appropriate documentation of referrals.
  • Ensure that referrals are addressed in a timely manner.
  • Assemble information concerning patient's clinical background and referral needs.
  • Works collectively with insurance carriers, patients and internal contacts to identify referrals and/or prior authorization requirements, and assists with securing these requirements before services are provided, resulting in timely reimbursement and final disposition of claims.
  • Communicates with the patient in a professional, courteous and respectful manner regarding appointment availability and appointment details.
  • Follows up with provider as needed for questions. Works collaboratively with provider, nursing, and rooming staff.
  • Work with Behavioral Health to assist with scheduling.
  • Responsible to ensure accurate and complete data for promptly registering patients, gathering, verifying and up-dating demographics, as well as insurance and benefit information to drive a timely billing process for our patients.
  • Explains topics of insurance coverage, treatment costs, and financial assistance opportunities to patients and/or family members.
  • Assist patients with obtaining VA authorizations and create referral shells within the EMR.
  • Completes the Utilization Review/Certification/Insurance Pre-Authorization form as required per established procedures and documents all pertaining information in the Utilization Notes.
  • Is involved in departmental quality and customer service improvement projects.
  • Assists with general office tasks.
  • Collaborates with other patient care and business-related functions to assure that our processes support a positive financial outcome for the facility and for the patient.
  • Assists with additional duties as assigned.
  • Represents GBAHC’s high standards for customer service in all telephone and face to face communication through courteous, patient and respectful conduct and conversation, while meeting the needs of all customers encountered.
  • Identifies and appropriately assist uninsured and under-insured patients with financial assistance.
  • Works closely with clinical departments to ensure that all necessary pre-service information is communicated timely and effectively.
  • Supports Gundersen Area Hospitals and Clinics’ mission, vision and values.
  • Maintains the security of patient financial information and records 100% of the time.
  • Complies with HIPAA policies and regulations 100% of the time.
  • Promotes a positive work environment; recognizes and acknowledges the efforts and accomplishments of others.
  • Attends 90% of department meetings.
  • Recommends to supervisor the ordering of equipment when necessary.
  • Communicates effectively with patients, employees, supervisor and other facility staff.
  • Follows safety rules and regulations 100% of the time
  • Protects and respects facility property, equipment and supplies.
  • Participates in facility safety drills and maintains compliance with Infection Control Practices.
  • Performs other duties as directed by the Director of Admissions.
  • Other duties as may be necessary to fulfill the responsibilities of this position. 
  • Fills in wherever needed in order to get the job done.

WORK RELATIONSHIPS AND SCOPE: Reports directly to Manager of Revenue Cycle.  Has contact with patients for, referral and prior authorization information, insurance information, billing and collection purposes. 

MEASURES OF PERFORMANACE: Quality, accuracy, timeliness, reliability and thoroughness of work performed.  Ability to gain the trust and respect of the Manager of Revenue Cycle, Finance Administrator, staff and other employees.  Ability to communicate effectively and develop good working relationships with others.  Soundness of business decisions made.  Ability to maintain the integrity of highly confidential business information

KNOWLEDGE, SKILLS AND ABILITIES: Requires a High School diploma.  Technical school certifications in healthcare or business program preferred.  Previous experience in a healthcare setting helpful.  Strong oral and written communication skills.  Knowledge of regulations related to collection activities preferred. Must be personable, positively assertive, and display professional competence. Ability to understand and follow hospital policies and procedures.

If you need assistance with any portion of the application or have questions about the position, please contact the recruiter listed below:

Primary Recruiter:

Jenny Dax

Recruiter Email Address:

[email protected]

Equal Opportunity Employer

Apply now Back to all job postings

1900 South Ave.
La Crosse, WI 54601

(608) 782-7300

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