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Top 50 Referral Specialist Skills

Below we've compiled a list of the most important skills for a Referral Specialist. We ranked the top skills based on the percentage of Referral Specialist resumes they appeared on. For example, 21.2% of Referral Specialist resumes contained Process Referrals as a skill. Let's find out what skills a Referral Specialist actually needs in order to be successful in the workplace.

These Are The Most Important Skills For A Referral Specialist

1. Process Referrals
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high Demand
Here's how Process Referrals is used in Referral Specialist jobs:
  • Receive and process referrals based on prior authorization protocols for Medicaid insurers.
  • Process referrals and scheduled appointments for outpatient testing and procedures.
  • Process referrals and verify insurances and obtain authorizations if required.
  • Worked in the referral department to coordinate and process referrals from primary care providers to specialty offices.
  • Request medical records from primary care providers, specialists, or hospitals to process referrals properly.
  • Build Files and process referrals, and send them off to the attorneys for review.
  • Obtain authorizations and process referrals within all the major managed care networks.
  • Process referrals and refer, when appropriate, to Case Managers.
  • Used knowledge of ICD-9 and CPT/HCPS codes to accurately process referrals.
  • Process referrals from MTF and Civilian providers and send letters.
  • Maintain records of completed as well as in-process referrals.
  • Process referrals or refer to Case Management.
  • Process referrals Respond to and resolve incoming referral problems, greet clients and record specific referral needs.
  • Evaluate and process referrals, notifications - authorizations for US Military, Veterans and their beneficiaries .
  • Manage and process referrals and prior authorization requests from clinics to payors and back.
  • Receive and process referrals based on standard procedures and policies of the healthcare service.
  • Process referrals using the Cerner Direct Connect referral system.
  • Process referrals, extensions, closeouts and terminations.
  • Process referrals and obtaim authorizations for over 90 medical doctors within Sutter Medical group.
  • Answered incoming calls Customer service/call center Process referrals for medical providers offices Route calls to appropriate resource Authorization/Pre-Certification knowledge Data Entry

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2. Insurance Companies
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high Demand
Here's how Insurance Companies is used in Referral Specialist jobs:
  • Obtained all prior authorizations required by insurance companies before any radiology tests were performed.
  • Communicated with various insurance companies in order to obtain patient insurance information.
  • Obtained authorizations from the insurance companies for specialist referrals and procedures.
  • Contacted insurance companies to verify patient benefits and eligibility for treatment.
  • Communicated with review organizations and insurance companies for coverage requirements;.
  • Contacted patient insurance companies to gain approval for referral appointments.
  • Coordinated with insurance companies when prior authorization is required.
  • Obtain authorizations from insurance companies.
  • Maintain liaison with insurance companies in order to ensure that all referral related activities are taken care of.
  • Verify insurance, send referrals to insurance companies to get approval/denial for patient to see specialist.
  • Call insurance companies to obtain benefits and authorizations for patients to access treatment services.
  • Submit insurance requests by phone, fax and websites with insurance companies.
  • Managed the process of getting the referrals approved by the insurance companies
  • Coordinated with insurance companies to ensure prior approval requirements were met.
  • Filled out 1500 forms and other pertinent information for insurance companies.
  • Make follow-up calls to the insurance companies.
  • Contacted insurance companies to find out if scheduled and planned procedures require preauthorization.
  • Complete insurance checks and obtain referrals/authorizations as required by individual insurance companies.
  • Obtain authorization via web or phone with insurance companies for global and/or diagnostic procedure requested.
  • Take phone calls from insurance companies that may need clinicals on patients.

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3. Customer Service
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high Demand
Here's how Customer Service is used in Referral Specialist jobs:
  • Collaborated with Customer Service Representatives via the CSR module to ensure referrals were processed for patient and/or provider referral inquiries.
  • Managed wide variety of customer service and administrative tasks to resolve customer issues quickly and efficiently.
  • Provide quality customer service and assisting clients identify resources in the community.
  • Demonstrated proficiency in timely resolutions to claims/customer service issues.
  • Provided customer service to providers.
  • Provide excellent customer service for providers and policy holders by answering calls relating to eligibility, authorizations, and claim issues.
  • Completed file audits and document retrieval at client and attorney request *Completed customer service functions and reports for client compliance
  • Leveraged key casework and customer service skills to conduct comprehensive needs assessment for each client and prepare service plan.
  • Manage the appointment schedules for physicians and follow up with patients to ensure satisfactory customer service.
  • Prepared and conducted team-based meetings addressing customer service needs, team competencies, and individual assignments.
  • Worked closely with nurses and scheduling staff for exemplary customer service for the patient's.
  • Demonstrate problem-solving skills, strong commitment to teamwork and customer service both internally and externally.
  • Provide customer service in both English and Spanish, serving a highly diverse population.
  • Utilized computer to do research and provide customer service and data entry for clients
  • Demonstrated mastery of customer service call script within specified time frames.
  • Perform multiple tasks simultaneously in a fast pace customer service environment.
  • Provided the highest level of customer service.
  • Provided reception to incoming and outgoing customers with exceptional and empathetic patient customer service; proficient with multi-line phones.
  • Performed administrative and clerical functions including phone referrals, customer service, paperwork/application processing, and fingerprint procedures.
  • Assisted customers with product complaints .Received multiple reviews acknowledging my level of dedication to excellent customer service.

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40 Customer Service Jobs

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4. Medical Records
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high Demand
Here's how Medical Records is used in Referral Specialist jobs:
  • Make recommendations in a training setting to improve procedures for compiling and retrieving medical records information.
  • Utilized electronic medical records to obtain prior authorizations for nuclear stress tests.
  • Maintained confidentiality and order of all medical records and correspondence for referrals.
  • Obtained and reviewed patient insurance information from medical records.
  • Scan medical records/documents into patient charts.
  • Reviewed medical records to identify diagnoses/procedures.
  • Provided office support including ICD-9 medical records and CPT coding, claim adjustments of UB92 and HFCA 1500 billing forms.
  • Fax patients medical records to specialist, making certain that the specialist will accept patients insurance.
  • Fax requested medical records & other documents to appropriate parties following HIPPA rules and regulations.
  • Assisted in the maintenance of medical charts and/or electronic medical records.
  • Processed and audit patient's medical records for specialist referrals.
  • Trained new receptionists in coding and transcribing medical records.
  • Prepare medical records prior to patient visit.
  • Maintain & update electronic medical records.
  • Document and enter all referrals appropriately in patients medical records.
  • Assisted in updating patient electronic health/medical records (Consolo).
  • Answer phones,filing medical records & some billing.
  • Scheduled new patient consultations for 29 cardiologists Tracked monthly testing and created reports Requested medical records while following HIPPA guidelines
  • Scheduled outside appointments to specialist Faxed medical records to specialist Contacted patients to confirm appointments
  • Scan data into patient's charts Medical Records Maintenance Assist multiple doctor's Appointment setting Filing Answering phones Translating

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5. Scheduling Appointments
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high Demand
Here's how Scheduling Appointments is used in Referral Specialist jobs:
  • Enter Patient information into system and updating existing customer information scheduling appointments for patients with specialists and physicians within the hospital.
  • Received inbound calls from new and establish patients regarding scheduling appointments
  • Operate telephone switchboard to answer, screen, or forward calls, providing information, taking messages, or scheduling appointments.
  • Assisted with receptionist duties including scheduling appointments, answering phone calls, faxing, scanning and emailing patient information.
  • Answer phones; check in patients, scheduling & rescheduling appointments, collecting co-pays and verifying patient insurance.
  • Managed all aspects of scheduling appointments, determining patient needs, and processing medical referrals.
  • Gather and record data from callers along with scheduling appointments for all drivers.
  • Assist patients in scheduling appointments with specialist, transportation, and translation needs.
  • Back up receptionist checking patients in and out, scheduling appointments.
  • Assist in scheduling appointments for clients as required in phone bank.
  • Assisted in scheduling appointments for various departments around the hospital.
  • Assist in scheduling appointments for patients with providers.
  • Assist patients with scheduling appointments.
  • Position Held: Patient Services Representative Responsibilities; Scheduling appointments, Customer Service Representative, Receptionist, Physician and R.N.
  • Verify insurance Obtain authorizations assist patients in scheduling appointments with specialists.

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6. Patient Care
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high Demand
Here's how Patient Care is used in Referral Specialist jobs:
  • Communicate with outside facilities/offices for patient care.
  • Use independent judgment and critical thinking skills to decipher clinical orders and make the best possible decisions regarding patient care.
  • Home Care Liaison, develop hospital and in home patient care plan and assessment to insure a smooth transition home.
  • Coordinate patient care with community partners, using available resources and maintaining an up-to-date list/notebook of all resources.
  • Provided Medical Office Expertise such as: initiating referrals to outside specialists for specific patient care needs.
  • Update the nursing staff and make sure all paperwork is updated and correct for patient care.
  • Coordinated patient care with off-base providers expediting the care of military members and their families.
  • Created an organizational system for tracking, organizing, documenting and scheduling patient care.
  • Evaluated patient care needs, prioritized treatment, and maintained patient flow.
  • Maintained accurate records of patient care, conditions, progress and concerns.
  • Manage patient care for military units to arrange care of patients.
  • Arrange patient care for specialist and diagnostic appointments.
  • Transport drugs prescribed patient care aids.
  • Scheduled appointments for patient care;.
  • Provided patient care and teaching.
  • Maintain positive and welcoming professional relationships with referral sources Provide superior patient care to individuals awaiting admission in department.
  • Facilitate patient care process through to completion; scheduling of appointments, arranging interpreters and transportation when necessary.
  • Obtain authorizations for physician referrals Coordinate patient care with physicians and specialty offices/facilities
  • Identify and attempt to resolve patient barriers to specialty care while, ensuring successful patient care and experience.
  • Communicate with providers in regards to patient care.

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40 Patient Care Jobs

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7. Data Entry
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high Demand
Here's how Data Entry is used in Referral Specialist jobs:
  • Ensured accurate data entry of all information collected.
  • Completed data entry and completion of referral forms/notifications.
  • Completed Receptionist and Data Entry assignments.
  • Entered alphabetic, numeric and symbolic data from source documents into computer, using data entry device, such as keyboard.
  • Managed various general office duties such as answering multiple telephone lines, scheduling office appointments, and data entry.
  • Performed clerical duties, such as word processing, data entry, answering phones and filing paperwork.
  • Keep and maintain confidential files including preparing monthly reports/QA and data entry in AIRS.
  • Record data entry and provide advocacy services for clients when necessary.
  • Conducted data entry; input procedure and ICD-9 codes in medical records
  • Assist co-workers, answer phones, data entry.
  • Perform data entry authorizations into the system.
  • Utilized computer for data entry for referrals.
  • Complete data entry and proof files.
  • Submitted authorization/referral requests and mailed to patients Data Entry, Insurance verification, and appointment scheduling
  • Front office Assistant/Insurance Coordinator Handle check in/check-out patients, data entry, records filing, appointment scheduling, and insurance verification.
  • Cross training of specimen processing tasks including processing, scanning requisitions, data entry, storaing specimens.
  • Interviewed court referred volunteers * Analyzed and processed court cases, data entry, cash handling responsibilities
  • Assisted Clinical Department with appointments and rooming of patients Accounts Collectible Verification of insurance and data entry
  • Speak with Humana members one on one Outbound and Inbound calls Data Entry working to meet company goals
  • Schedule appointments for members with specialist Answer Phones Language translation for doctors and members Data Entry Prep Medical claims Money Handling

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5 Data Entry Jobs

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8. Phone Calls
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high Demand
Here's how Phone Calls is used in Referral Specialist jobs:
  • Answered incoming phone calls from patients, other medical facilities & practices, as well as, relayed messages to physicians.
  • Answer incoming chat messages, SMS text and phone calls to schedule appointments ate area food pantries for Franklin County residents.
  • Assist in administrative duties including typing, filing, mailings, answered and directed phone calls and development of program materials.
  • Handle incoming and outgoing phone calls to Waiver and Long Term - Personal Care Services (LT-PCS) applicants and recipients.
  • Receive incoming phone calls for the department, provide information, document calls and relay messages.
  • Processed faxes and phone calls for prior authorization, sent faxes back to providers.
  • Handle daily phone calls to help patients with referral and insurance questions.
  • Answer inbound phone calls from providers, insurance carriers & patients.
  • Answer patient phone calls, assist patients with scheduling of appointments.
  • Answer, screens and directs phone calls to appropriate department.
  • Answered escalated phone calls and responded to urgent e-mails.
  • Obtain authorizations, paperwork, phone calls, etc.
  • Schedule appointments, answer and screen phone calls.
  • Documented phone calls and interactions with providers.
  • Answer high volume of phone calls.
  • Answer high-volume patient phone calls.
  • Receive phone calls, walk-ins, and faxes.
  • Answer phone calls with an appropriate tone of voice, paying close attention to voice inflection and volume.
  • Triaged phone calls to start prior authorization cases.
  • March 2013 to September 2013 Handled volume phone calls/walk-ins for Information and Referral first response srvcs.

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2 Phone Calls Jobs

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9. Crisis Intervention
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high Demand
Here's how Crisis Intervention is used in Referral Specialist jobs:
  • Provide information and referral for community services, stabilization counseling, and crisis intervention services to clients via telephone and internet.
  • Collaborate closely with local crisis intervention services and law enforcement to develop appropriate intervention techniques vital to diffusing dangerous situations.
  • Direct caller to appropriate crisis intervention services, including domestic violence and potential suicide.
  • Provided advocacy, suicide intervention, crisis intervention, dispatch emergency assistance when needed.
  • Managed crisis intervention and behavior management with patients requiring inpatient mental health admissions.
  • Provided crisis intervention counseling and supported callers through a rational resolution oriented process.
  • Aided in crisis intervention and provided and/or received information on volunteer opportunities.
  • Provide advocacy, crisis intervention, and emergency readiness for community demands.
  • Perform crisis intervention for potential patients and process patient admissions.
  • Provide crisis intervention and assist callers in identifying coping strategies.
  • Provided crisis intervention for chemical dependency and suicidal patients.
  • Developed case management and crisis intervention skills.
  • Implement crisis intervention in endangerment situations.
  • Provided counseling and crisis intervention for Haitian immigrants entering the United States for the first time after the Earthquake in Haiti.
  • Provided crisis intervention, group, individual and family therapy as well as assisting clients with treatment and discharge planning.
  • Maintained effective listening skills, information and referral and crisis intervention services to callers in 24/7 call center setting.
  • Provide crisis intervention counseling, possess knowledge of DSM diagnostic criteria and collaborate with government agencies.
  • Provided emotional support and crisis intervention to distraught callers throughout the state.
  • Trained on how to be prepared to handle crisis intervention situations.
  • Provide empathetic listening/problem solving, crisis intervention, and/or suicide intervention following 2-1-1 Broward principles, policies and procedures

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10. CPT
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high Demand
Here's how CPT is used in Referral Specialist jobs:
  • Arranged for debt repayments or established repayment schedules and sent out insurance claims with the correct ICD-9 and CPT codes.
  • Review of medical documentation for accurate ICD-9 diagnosis coding and CPT code assignment for a wide range of services.
  • Audited receptionists for accuracy in ICD-9/CPT coding to ensure that services billed were documented in the medical record.
  • Verify insurance coverage Assigned appropriate ICD-9/CPT diagnosis codes to accurately support the need for each physician service.
  • Trained staff on referral database, while utilizing proper CPT and ICD10 codes for insurance authorizations.
  • Provide patient referrals and authorizations to medical providers based on ICD-9 and CPT codes.
  • Insured ICD9 codes and CPT codes are correct for patient diagnosis and billing.
  • Certified correct CPT codes for billing purposes with physicians and the insurer.
  • Enter notifications, verify provider status and confirm ICD and CPT coding.
  • Experience with medical coding ICD-9 and CPT code with Medicare and Medicaid.
  • Research CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
  • Extended use of CPT Codes, ICD-9 Codes and Medical Terminology.
  • Maintain up to date CPT/ICD-10 codes for testing and procedures.
  • Utilized CPT and ICD-9 codes to see if they qualified.
  • Completed notification wizard along with ICD-9 and CPT coding.
  • Confirm if specific CPT codes require prior authorization.
  • Experience in CPT and ICD-9 coding
  • Enter and verify all procedures codes such as, CPT, ICD9 and ICD 10 for processing of clinical information.
  • Assist providers with verifying if particular CPT codes need authorization Responsible for obtaining appropricate referral information from various provider's.
  • Entered patient information, ICD-9/CPT codes into data base * Check-in./Check out * Prepared charts for doctor * Scanned * Scheduled appointments

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11. Medicaid
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high Demand
Here's how Medicaid is used in Referral Specialist jobs:
  • Advised Medicaid Recipients about the various medical assistance programs & provided information about the various services covered by Medicaid.
  • Experience with conducting health care and insurance investigations including Medicare, Medicaid/Medical Assistance for Maryland, and private insurances.
  • Completed nursing facility authorizations using TrueCare software for Medicaid members in Residential care.
  • Utilized passport to verify insurance coverage for clients on Medicare/Medicaid.
  • Logged and copied all secured Medicaid applications daily.
  • Review and process Medicaid therapy authorization request for Outpatient Specialty Therapies (Physical, Occupational, and Speech Therapy).
  • Determined eligibility for Public Assistance Programs for Medicaid, Food Stamps, Disability Assistance, and Emergency Assistance Programs.
  • Complete authorizations for Medicaid and address various questions to assist providers for excellent care of the members.
  • Handled referrals for all insurances including HIP, Medicaid, Medicare, managed and private plans.
  • Assured the timely & accurate delivery of all Medicaid applications to social service offices.
  • Assist doctors and nurses with Medicare and Medicaid guidelines for accuracy and completeness.
  • Place families on the statewide wait list for Medicaid Long Term Care.
  • Aided in filling out applications for Medicaid, disability, and transportation.
  • Assessed eligibility for Medicaid, Public Benefits, and other programs.
  • Have extensive knowledge of managed care and Medicaid and Medicare criteria.
  • Adhere to the Medicaid procedures and guidelines within NCQA.
  • Answered incoming calls from CHIP and Medicaid members.
  • Obtained health insurance verifications and referrals (including Medicare & Medicaid) for office visits and surgeries on a daily basis.
  • Process referrals and task to assigned Case Managers Knowledgeful in ICD10 coding Review Medicaid guidelines Review members file for duplicate request.
  • Assisted in Texas Health and Human Services call transfrers SNAP, TANF, Medicaid.

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5 Medicaid Jobs

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12. Patient Referrals
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high Demand
Here's how Patient Referrals is used in Referral Specialist jobs:
  • Obtained prior authorizations from insurance companies according to the specific guidelines of each insurance company for patient referrals to specialists
  • Performed patient referrals and authorizations by completing and submitting documents and discussing with providers, insurance carriers and patients.
  • Manage and confirm all patient referrals with practitioner office and insurance carriers to determine eligibility of payment.
  • Key Accomplishments: o Developed and maintained systematic procedures for physician referrals and patient referrals.
  • Assisted in gathering monthly and quarterly statistical data to identify opportunities for increased patient referrals.
  • Obtained authorizations for patient referrals and maintained accurate records.
  • Completed initial intakes for hospital patient referrals.
  • Cross-referenced patient referrals with physicians offices.
  • Expedited patient referrals to specialty offices, faxed medical records, answered patient and specialty office calls and completed referral requests.
  • Managed and tracked patient referrals internally, identified trends of recaptured care, and promoted continuity of care.
  • Managed patient referrals from insurance companies to medical specialists for a 20 physician practice.
  • Processed patient referrals to physicians, specialists, and hospital facilities.
  • Obtained all new patient referrals and made appointments.
  • Processed 40-50 patient referrals on a daily basis.
  • Request reports from patient referrals to specialists.
  • Log and track all patient referrals.
  • Processed patient referrals and insurance forms.
  • Worked independently dealing with insurancecompanies and patient referrals to various specialists.
  • Processed all incoming new patient referrals, both Internal (within the Rockwood system) and External referrals from outside providers.
  • Interfaced with nurses, physicians, and healthcare providers regarding outpatient referrals and patient needs.

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13. Child Care
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high Demand
Here's how Child Care is used in Referral Specialist jobs:
  • Collected, maintained and disseminated child care resource information and consumer education to parents.
  • Determined family eligibility for subsidized child care services.
  • Prepared child care provider reimbursements.
  • Provided support & consultation to child care providers by helping them increase their quality of care through education and licensing.
  • Conducted community awareness through presentations to employers and other community partners about the needs and solutions to child care.
  • Educated parents on what quality care looks like and helped them find child care that meets their needs.
  • Continue to advocate in the struggle to place special needs children in the best child care placements available.
  • Solicit provider information from all possible child care sources; update provider information on a continual basis.
  • Analyze and utilize reports, studies and research on child care issues to improve the agency services.
  • Communicate with Child Care Providers of Monmouth County to discuss the programs that they offer to families.
  • Provided training to parents and providers in licensing, literacy, and other child care topics.
  • Maintained the resource and referral child care database, for a two county area.
  • Conduct outreach and perform presentations on services rendered at DC Child Care Connections.
  • Provide technical assistance and training for child care providers Coordinating events and seminars.
  • Educate and assist parents in the process of selecting quality child care.
  • Solved problems between the agency, families and child care providers.
  • Updated information for designated families and child care providers.
  • Continue to counsel families on choosing Quality Child Care.
  • Supported management staff of Child Care Initiative Project.
  • Provide technical assistance for child care providers.

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3 Child Care Jobs

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14. Physician Offices
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high Demand
Here's how Physician Offices is used in Referral Specialist jobs:
  • Provided information to referring/rendering physician offices and network imaging centers regarding program requirements.
  • Contacted physician offices as needed to obtain demographic information or related data.
  • Entered demographic and screening information from requesting physician offices and providers.
  • Contacted physician offices for procedure and medication authorizations as needed.
  • Collated all important patient information from referring physician offices.
  • Contacted Physician offices/hospitals/vendors to gather any missing information.
  • Answer calls from physician offices, hospitals, and patients using exemplary customer service skills.
  • Answered calls from physician offices, insurance companies, and patients.
  • Provided unparalleled quality of customer service to referring physician offices and imaging facilities in regards to case inquiries.
  • Initiated and managed clinical referrals for pre-authorization, including contacting physician offices to obtain demographic data.
  • Communicated referral and precert info to internal staff, external physician offices, and surgery centers.
  • Entered demographic and screening information from requesting physician offices or provider via the pre-cert system.

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2 Physician Offices Jobs

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15. Mental Health Services
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average Demand
Here's how Mental Health Services is used in Referral Specialist jobs:
  • Provided resources, education, and referrals to mental health services, empowering to clients to achieve independence.
  • Assisted management in establishing policies and procedures for processing complex client referrals for mental health services.
  • Coordinate mental health services for 150+ patients per week in skilled nursing facilities.
  • Provided singe point entry into after-hours mental health services.
  • Quoted Benefits to Callers for Mental Health Services Approved and authorized Mental Health Benefits for in and outpatient services.
  • Provide information and referrals for mental health services Initiate case management and advocacy to ensure linkage to services requested.
  • Triaged all distress calls to Access Center Acquired future customer demographics Processed walk-in clients for mental health services

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16. Primary Care Services
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average Demand
17. Medical Services
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average Demand
Here's how Medical Services is used in Referral Specialist jobs:
  • Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations.
  • Resolved payment denials related to medical services rendered, without prior authorization.
  • Create authorizations for outpatient and inpatient medical services and durable medical equipment.
  • Arrange physician to physician consultations, transportation for admission by Arch Air Medical Services or Abbott Ambulance.
  • Authorize medical referrals based on patient contracts, medical services and Group Health guidelines.
  • Position Purpose: Assist in monitoring utilization of medical services to assure cost.
  • Assist in monitoring medical services to assure cost-effective use of resources.
  • Investigate case discrepancies on cash, food stamps and medical services.
  • Verified insurance benefits and obtained prior authorizations for All medical services.

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18. Community Resources
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average Demand
Here's how Community Resources is used in Referral Specialist jobs:
  • Received calls from service recipients, screened for appropriateness and eligibility, provided community resources and the proper agency assignment.
  • Provided appropriate information on community resources for elders and persons with disabilities living in the Merrimack Valley.
  • Demonstrated technical and active listening skills by providing accurate community resources to inquiring callers.
  • Developed relationships with community resources through outreach in all surrounding counties.
  • Assist people in accessing caregiver and senior related community resources.
  • Produced daily and monthly reports and provided community resources.
  • Develop and maintain information database of 70,000+ community resources
  • Identify and utilize cultural and community resources.
  • Connected individuals and families to community resources
  • Advocated for clients, researched and updated community resources, networked in the community with other aging professionals.
  • Assess and seek to resolve any issues the customer may be experiencing utilizing internal and community resources.
  • Provide information to applicants about community resources and department resources and how to use the information.
  • Build and maintain multiple working relationships with partnering non-profits, clinics, and other community resources.
  • Interviewed service providers, community resources and non-profit agencies to determine breadth of services offered.
  • Consulted by phone and in person, with individuals and families requiring community resources.
  • Initiated referrals for clients to various human service agencies and community resources.
  • Provided community resources and information to clients to meet their needs.
  • Determine patient insurance eligibility, conduct insurance verification/pre-certifications, patient advocacy and provide community resources/referrals.
  • Greet Patients, serve beverages, and snacks Answer questions and refer patients to alternative community resources and additional services
  • Answered in-bound and conducted out-bound calls for Missouri and Illinois residents in need of community resources.

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19. Appropriate Referrals
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average Demand
Here's how Appropriate Referrals is used in Referral Specialist jobs:
  • Gathered and assessed necessary data and information to form strategic decisions and to provide appropriate referrals to clients.
  • Navigated and arranged programs in the primary database to provide appropriate referrals and recommendations as needed.
  • Organize and coordinate appropriate referrals for Chemical Dependency Service.
  • Maintained knowledge base necessary to make appropriate referrals.
  • Make appropriate referrals for non-Medicaid community services.
  • Assist a diverse population with their needs and makes appropriate referrals to social services agencies, programs and services.
  • Screen all callers requesting treatment to find out eligibility for treatment and make appropriate referrals to a provider treatment.
  • Work closely with Physical Evaluation Board to ensure appropriate referrals for specialty for Medical Evaluation Board participants are met.
  • Review medical records, discharge notes, hospital notes, and all other required documentation to determine appropriate referrals.
  • Provided appropriate referrals to clients, both in English and Spanish, facing financial hardship and mental health crisis.
  • Empower inquirers by providing information that will enable them to choose the most appropriate referrals for their need.
  • Assessed the callers need and made appropriate referrals when necessary.
  • Provide appropriate referrals to drug treatment if needed.
  • Communicate with wide variety of callers, assess their needs and give appropriate referrals for human services field.

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1 Appropriate Referrals Jobs

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20. MRI
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average Demand
Here's how MRI is used in Referral Specialist jobs:
  • Schedule appointments for patients with specialists, MRI's, Ultrasounds, CT Scans, and procedures.
  • Obtain any recent MRI scan, or CT scan done at any other facility outside of Yale.
  • Obtained prior authorization for both specialty tests to include Nuclear stress & MRI/MRA.
  • Schedule MRI and CT Scans at Yale or any facility outside of Yale.
  • Schedule all testing, including all radiology (MRI's CT's etc.)
  • Schedule imaging tests like MRI's, CT's, etc.
  • Get RQI for MRI, and CT Scans.
  • Precerted outpatient radiology procedures, CT scans, MRI's, inpatient admissions, chemotherapy drugs, growth factors, etc.
  • Cancel and reschedule patients appointments Schedule patients for MRI/CT's and any other ancillary testing.
  • Refer patients for tests such as MRI, CT, Xrays, etc.
  • Verified Insurances, obtained pre-certification for all CT and MRI procedures for all facilities, verified CPT/ICD codes were correct.
  • Obtained Referrals and authorizations Scheduled MRI's and EMG's Processed workers' compensation forms for physicians

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21. Patient Demographics
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Here's how Patient Demographics is used in Referral Specialist jobs:
  • Navigate and maintain electronic medical records, entering patient demographics and monetary transactions.
  • Gathered/organized data from patient demographics & hospital / patient representative notes.
  • Tabulated new referral patient demographics on a regular basis.
  • Verify patient demographics and insurance eligibility with payers.
  • Handled data entry for hospital staff, and patient demographics.
  • Checked the patient demographics on all new referral patients.
  • Collect co-pays, verify insurance and patient demographics.
  • Update patient demographics in database.
  • Update and correct patient demographics * Verify insurance eligibility through automated system as well as internet websites.
  • Obtained patient demographics and assigned referrals to appropriate staff.
  • Verify insurance and patient demographics information.

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22. Front Desk
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average Demand
Here's how Front Desk is used in Referral Specialist jobs:
  • Job duties: Maintaining the smooth running and operation of all front desk activities in a busy medical practice.
  • Help front desk schedule appointments, verify patient's insurance information and collecting co-payments at time of visit.
  • Obtain prior authorizations, verify benefits, outgoing referrals, cover front desk and back office when needed
  • Update charts tracing referrals, working with front desk to remind patients who may need upcoming referrals.
  • Managed the front desk/office in the areas of scheduling, billing, and medical insurance records management.
  • Started off as a floater where I learned front desk, referrals and courier.
  • Support for front desk check in and check out and scheduling of appointments.
  • Started with front desk and reception, quickly adding the responsibilities of referrals.
  • Coordinated front desk, helped out problem calls and filed patient charts.
  • Filled in for front desk reception and assisted in chart filing.
  • Assisted in front desk and billing department duties.
  • Work front desk checking patients in and out.
  • Performed front desk duties as needed.
  • verified insurance, made appointments for patients, high volume specialist contact, assisted in all front desk duties.
  • Cover front desk for Primary Care, Consult & Weight Management Clinics as needed Patient Services Representative II
  • Front desk- check-in/check-out patients, send/receive referrals to clinical, schedule patient appoinments.
  • Front Desk Check in an out patients.
  • Front Desk Associate Handled incoming calls.
  • Prepped charts daily Verified insurances Customer communication, at front desk and phones.
  • Front desk North Syracuse, NY Schedule patient appointments.

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23. Pertinent Information
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Here's how Pertinent Information is used in Referral Specialist jobs:
  • Tasked with accurate documentation of phone calls to include demographic data and other pertinent information that would assist with data management.
  • Verify available insurance coverage and enter referrals, communications, actions, and other pertinent information into the medical management system.
  • Obtained pertinent information deemed necessary for crisis counselor's interaction and intervention.
  • Communicate pertinent information to designated person and/ or persons through documentation.
  • Gathered pertinent information from client to identify needs and eligibility.
  • Document and communicate pertinent information to team members and customers.
  • Documented per protocol and communicated pertinent information to designated person.
  • Provided pertinent information to help ensure understanding of hospice overall, and LCFH in particular.
  • Conducted client Interviews to elicit pertinent information necessary to qualify them for the proper services.
  • Search resource database for programs and services and provide pertinent information to clients.
  • Gathered all pertinent information from referring physician office for a new consult.
  • Document per protocol and communicate pertinent information to designated person Provide clinical guidance to internal and external customers
  • Gathered pertinent information Registered patients for visits with the physician.
  • Assisted patients in interpreting insurance billing and resubmission of pertinent information in regards to their denied claims

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24. Outbound Calls
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Here's how Outbound Calls is used in Referral Specialist jobs:
  • Performed outbound calls to providers to gather required information that was used to verify the patient information and dates of procedures.
  • Handle customer inquiries via telephone, Internet, e-mail for Inbound and Outbound calls relating to Cedars-Sinai Hospital based in California.
  • Make outbound calls to provide offices to verify demographic information as well as confirmation of access to care standards.
  • Place outbound calls to follow -up with a percentage of our callers to determine if their needs were met.
  • Received incoming calls, conducted outbound calls, and returning messages to identify and determine the needs of callers.
  • Manage denied claims, from outbound calls to commercial and government payers to check claim status.
  • Advance experience in outbound calls to provide support and pertinent information to designated persons i.e.
  • Answer inbound calls and make outbound calls regarding patient care in call center environment.
  • Make outbound calls as needed to providers to gather required information for referrals.
  • Conduct outbound calls, reminding Ross Eye Institute clients of their appointments.
  • Handled all inbound and outbound calls according to company policies and guidelines.
  • Make outbound calls to members to inform them about case management program.
  • Make outbound calls to providers to gather request information for referral.
  • Place outbound calls to in-house referrals to market mini-vacation packages.
  • Redirected inbound and outbound calls to appropriate level of review.
  • Handled inbound and outbound calls for members and provider.
  • Regulate and manage inbound/outbound calls.
  • Received inbound calls and made outbound calls to members to inform them of added benefits to their current plans with Humana.
  • Process Incoming Referrals Patient Outreach via Outbound calls Schedule Appointments Insurance Verification/Authorization System Knowledge: EPIC (Dimensions)

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25. Authorization List
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Here's how Authorization List is used in Referral Specialist jobs:
  • Initiate Authorization requests for OT, PT and ST Evaluations and Re-evaluation services in accordance with the prior authorization list.
  • Initiated authorization requests for output or input services in keeping with the prior authorization list in a call center setting.
  • March 2007 - April 2012 Initiate authorization requests for output or input services in keeping with the prior authorization list.

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26. Inpatient Services
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Here's how Inpatient Services is used in Referral Specialist jobs:
  • Ensured efficient collaborations with medical personnel and adeptly provided inpatient services and referrals to patients and patient systems.
  • Initiate authorization request for outpatient and inpatient services in accordance with prior authorization list.
  • Initiate authorization requests for outpatient and inpatient services in accordance with the department guidelines.
  • Initiate authorization request for outpatient and inpatient services.
  • Entered assessments and authorizations into the system Initiated authorization request for outpatient and inpatient services in accordance with the prior authorization.

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27. Appropriate Person
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Here's how Appropriate Person is used in Referral Specialist jobs:
  • Greet callers and handle their inquiries or direct them to the appropriate persons according to their needs.
  • Answer multi-line telephones, screen and route calls to appropriate personnel.
  • Obtain Pre-authorization for Diagnostic Testing Schedule Patients for Diagnostic Testing/Specialty Doctors Answering multi-line phones and Directing to the Appropriate Person/Dept.

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28. Durable Medical Equipment
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Here's how Durable Medical Equipment is used in Referral Specialist jobs:
  • Initiated authorization requests for Durable Medical Equipment in accordance with the prior authorization policies.
  • Processed prescription requests for durable medical equipment for multiple insurance carriers.
  • Entered outgoing referrals for primary care physicians referring to specialist or for Durable Medical Equipment.
  • Processed Precertification and Authorizations for Admissions, Urgent Care, Radiology referrals and durable medical equipment.
  • Collaborated with the company'sconsultant on durable medical equipment requests.
  • Investigated durable medical equipment request, complaints for amputees who were in need of prosthetics.
  • free gym memberships, meal programs, durable medical equipment etc.

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29. Phone Queues
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average Demand
Here's how Phone Queues is used in Referral Specialist jobs:
  • Provided customer service by answering phone queues, faxes and prior web authorizations within established standards.
  • Answer phone queues and process faxes and approval letters within established standards.
  • Answer phone queues, process faxes and web request within established standards.
  • Respond via fax to customers Enter authorization into system Answer phone queues
  • Answer phone queues and process faxes
  • Verify eligibility and benefits Answer phone queues and process faxes within established standards
  • Respond to telephone queues and process them in a timely manner.
  • Verify eligibility and benefits Answer phone queues and process faxes within established standards Data enters authorizations into the system.
  • Route to appropriate staff when needed.Verify eligibility and benefitsAnswer phone queues and process faxes within established standards
  • Route to appropriate staff when needed.Verify eligibility and benefitsAnswer phone queues and process faxes within established standardsData enters authorizations into the system

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30. EMR
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low Demand
Here's how EMR is used in Referral Specialist jobs:
  • Maintain accurate EMR documentation of all service given to patient under strict confidentiality.
  • Used Medical Manager/EMR system to update demographics
  • Assisted Providers with denial/approval codes for CPT codes inquired upon and handled Incoming EMR faxes and set up for review for nurses
  • Entered all referrals related data into the EMR, making corrections and/or updating as necessary.
  • Scan all prior authorization received by mail or via fax in patient's EMR.
  • Direct contact with physicians regarding prescriptions and refills, established with patient EMR program.
  • Monitor electronic referral boxes in Electronic Medical Record (EMR) system.
  • Entered orders into the EMR system efficiently and with minimal errors.
  • Reviewed 6 doctors EMR notes and began authorization and referral process.
  • Prepare and scan all records received into patient's EMR.
  • Assisted in the maintenance of medical charts using EMR.
  • Scanned all documents into the patients EMR.
  • Document authorizations & appointments in EMR system.
  • Experience with EPIC, EMR, IDX, and PCIS.
  • Answer telephone, schedule patients, check in, and check out patients using EMR EClinical Works.
  • Experience in EMR data entry & eClinicalWorks 9.0 software.
  • Update EMR/Cerner with changes and updates.
  • Authorized specialist appointments, radiological exams and medication pre-authorizations Kept doctors' referral results up to date in EMR
  • Answered phones, use of Aprima EMR, Insuranceverification, authorization, checking in/out patients, scheduling, experience in HMOs.

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31. Computer System
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low Demand
Here's how Computer System is used in Referral Specialist jobs:
  • Developed at-a-glance workbook of new computer system for assessment team increasing accuracy and speed of patient admissions.
  • Add referral/authorization information into computer system as received from insurance carrier or PCP office.
  • Retrieved specialty information to set up in HealthEast practice management computer system.
  • Operated and navigated numerous computer systems in order to determine eligibility
  • Input patient demographic information into computer system.
  • Registered patient demographics into hospital computer system.
  • Enter data authorizations into computer system.
  • Answered incoming phone calls, input authorization requests into the computer system for review by the referral nurse or medical director.
  • Acquired a quick grasp on the computer system and could find information quickly to help with customer inquiries.
  • Assisted with implementation of new computer system (KIDS 2100) to process incoming information more efficiently.
  • Use the HMS computer system to input patient data and prepare a patient to be admitted.
  • Submitted customers' cases into a computer system to deal with the specific inquiries and concerns.
  • Utilize computer systems to receive and transmit electronic mail.
  • Entered demographic and screening information from requesting physician office or provider via telephone or facsimile into the preauthorization computer system.
  • Use Amysis computer system to verify affiliation of providers and facilities with Peach State Health Plan and Ambetter Marketplace Insurance.

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10 Computer System Jobs

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32. Clinical Staff
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low Demand
Here's how Clinical Staff is used in Referral Specialist jobs:
  • Assisted clinical staff with relevant participating provider requirements and with locating in-network specialists approved by the primary care provider as necessary.
  • Communicated clearly with clinical staff to advocate on behalf of patients while strictly adhering to patient privacy and confidentiality.
  • Delivered timely and accurate mental health evaluations and allocated clinical staff according to patient requirements.
  • Received incoming requests for imaging, procedures, and treatments from physicians and clinical staff from up to six clinics daily.
  • Provide support to clinical staff in order to facilitate the administrative components of clinical referrals for various services.
  • Attended to patient needs by greeting, communicating via phone, and taking messages for clinical staff.
  • Worked closely with physicians and clinical staff to ensure patient satisfaction of services provided.
  • Assist providers and clinical staff with overdue task list, medication refills, etc.
  • Worked closely with physicians and clinical staff pertaining to billing practices and policies.

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33. Hippa
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low Demand
Here's how Hippa is used in Referral Specialist jobs:
  • Protected all confidential member information by following HIPPA standards.
  • Maintained strictest confidentiality, adhered all HIPPA guidelines/regulations.
  • Verify customer identity according HIPPA procedures.
  • Screen patients, ensure financial eligibility for Department of Community Health, and provide HIPPA related forms to patients.
  • Verify patient's demographic and insurance information in compliance with the National Registration Standards and HIPPA policies.
  • Worked within confines of HIPPA regulations to release medical information to facilities as well as patients.
  • Faxed medical records and prescriptions to specialty clinics and hospitals abiding by HIPPA regulations.
  • Search for patient accounts in databases using sensitive information according to HIPPA guidelines.
  • Maintained compliance with Federal, State, and local regulations and HIPPA.
  • Answer all phone calls and route them according to HIPPA regulations.
  • Keep up-to-date on HIPPA guidelines to ensure privacy of consumers.
  • Adhered to HIPPA standards when working with personal health information.
  • Completed all necessary training pertaining to HIPPA and privacy acts.
  • Confirm that all scheduled appointments are HIPPA compliant.
  • Filed HIPPA sensitive documents in appropriate charts.
  • Adhere to confidentiality and HIPPA regulations.
  • Follow HIPPA and company guidelines accordingly.
  • Reviewed/analyzed referral requests; patient registration/vitals/charting/scheduling; determined eligibility/insurance authorizations; office equipment & inventory management; followed HIPPA regulations/laws
  • Maintained patient confidentiality and abided by all HIPPA guidelines.
  • Ensured compliance of all federal and state healthcare laws; Privacy Act & HIPPA requirements.

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34. Hipaa
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low Demand
Here's how Hipaa is used in Referral Specialist jobs:
  • Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling patient information.
  • Work closely with Utilization Management to ensure submission accuracy and HIPAA compliance.
  • Complied with HIPAA Privacy and Security Regulations handling patient information.
  • Maintain confidentiality by following all applicable HIPAA regulations.
  • Input HIPAA information, call physician offices to verify testing, collect copay's and deductibles.
  • Completed and maintained HIPAA and Medicare FWA course education as standard per all compliance guidelines.
  • Enter client data into a secure database in compliance with federal HIPAA regulations.
  • Reviewed all paper work for completion and compliance with HIPAA and JACHO regulations.
  • Completed over 5000 patient care request referrals without a HIPAA violation.
  • Follow HIPAA and IMPOWER policies regarding confidentiality of client records.
  • Adhered to HIPAA standards when working with protected health information.
  • Maintained compliance of HIPAA regulations while performing daily job activities.
  • Exercised HIPAA / PHI / Authorized Disclosure Compliance.
  • Fulfilled monthly mandatory trainings and performed within HIPAA regulations daily.
  • Checked CPT, ICD 9 codes and HIPAAinformation.

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35. Tricare
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low Demand
Here's how Tricare is used in Referral Specialist jobs:
  • Processed on a daily basis TRICARE referrals for beneficiaries and mentored new referral specialists
  • Processed inbound referrals from Military Treatment Facilities seeking authorizations for TriCare beneficiaries.
  • Verified patient eligibility utilizing DEERS and TRICARE systems.
  • Processed medical referrals for TRICARE beneficiaries.
  • Processed incoming physician referrals for insured's with TriCare Military Insurance, to visit other physicians.
  • Corresponded with providers to ensure proper billing procedures for all TRICARE beneficiaries.
  • Conducted provider and patient education of the TRICARE program.
  • Verify patients medical eligibility through DEERS/TRICARE and CHCS.
  • Service matter expert on benefit/coverage of Tricare program.
  • Provided Tricare program recommendations to Military personnel.
  • Obtain authorization letters issued or Tricare Prime patients receiving care outside the facility and for payment approval to those facilities.
  • Stay current with all Humana Military and TRICARE policies, procedures and applications * Coordination of Benefits with primary insurance
  • Helped find a doctor that accepted Tricare and notified patient as soon as it was processed.

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36. Human Service
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low Demand
Here's how Human Service is used in Referral Specialist jobs:
  • Demonstrated comprehensive understanding of the human services delivery system including community resources, organizations, and services.
  • Conducted intakes by assessing the needs of individuals seeking assistance with human services and other community-based resources.
  • Provided information/referral regarding eligibility criteria for human service programs through the use of database.
  • Provided information and referrals to over 600 callers per month regarding health & human service resources statewide through an online database.
  • Maintained documentation that supports the scope of services as required in the contract with the Department of Human Services.
  • Provide health and human service referrals to local government, non-profit and faith-based agencies via telephone to inbound callers.
  • Provide advocacy for clients when needed by interacting with clients and human service agencies resolving problems and providing information.
  • Answer inbound calls, providing links to health and human service organizations for a wide variety of consumers.
  • Assist low income families, individuals, seniors and persons with disabilities with health and human services.
  • Provided information and referral services to callers inquiring about health and human service resources in their community.
  • Trained childcare providers, parents, and community agencies on TN Department of Human Services approved classes.
  • Received calls and emails from individuals seeking information and assistance to solve their human service needs.
  • Assessed callers' needs and provided information and referrals to health, legal and human services.
  • Assess client's needs and provide accurate information and referrals to human service agencies.
  • Developed a resource guide to local organizations that provide human services in the community.
  • Connect families with human services and licensed child care in their community.
  • Hand inquiries for information and referral to health and human services.
  • Navigated comprehensive database of human service and government agencies to provide ongoing referrals for selected cases.
  • Established and maintained formal and informal cooperative arrangements with human service agencies in the community.
  • Referred hotline callers and walk-in clients to local health and human services, governmental agencies and nonprofits.

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37. Social Workers
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low Demand
Here's how Social Workers is used in Referral Specialist jobs:
  • Faxed reports to supervisors/social workers.
  • Make appointments for classes, special events and Social Workers both in person and on the phone.
  • Managed referrals from social workers, case managers, nurses, doctors, families and patients.
  • Educated clients about ElderHelp's programs and referred screened clients to agency social workers.
  • Work directly with Social Workers and Case Managers to create financial plans for patients.
  • Interfaced with hospital financial counselors and social workers as well as patients.
  • Worked as a fulltime Psychiatric Referral Specialist with a multi-disciplinary team consist of doctors and social workers.
  • Performed assessments and typed reports on the Elder Abuse hotline for Los Angeles County, and faxed reports to supervisors/social workers.

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38. Health Care
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low Demand
Here's how Health Care is used in Referral Specialist jobs:
  • Assisted with the daily retrieval and transfer of referral data from Composite Health Care System into database for tracking purposes.
  • Displayed adaptability and efficiency with seamless transfer through United Health Care (UHC) ever evolving referral management process.
  • Make direct contact with community agencies and health care providers who can assist in meeting patient s needs.
  • Assist patients in problem solving potential issues related to the health care system, financial or social barriers.
  • Answer inquiries from health care providers helping them to understand the prior authorization process and current guidelines.
  • Directed patient to resources regarding their health care, financial problems, or social barriers;.
  • Call center support, answer 10-20 phone calls/day from health care providers in multiple states.
  • Identify the particular health care needs of individuals in a community or target area.
  • Initiate contact with Health Care Provider (HCP) clients by phone or fax.
  • Manage consultations and account for required medical results to the ordering health care provider.
  • Assisted, guided, and educated patients and families on behavioral health care system.
  • Updated Data base with current clinic information for the 489-Care Health care line.
  • Worked on obtaining backlogged referrals for Home Health Care services for MassHealth patients.
  • Corresponded with other health care providers for proper set up of patient treatment.
  • Answered incoming calls from PA residents inquiring about health care coverage.
  • Schedule appointments with ancillary departments or other health care providers.
  • Referred clients to a health care specialist when needed.
  • Maintain up-to-date knowledge of all health care plans.
  • Assist health care providers with claim questions/issues.
  • Participated in the promotion of the multi-disciplinary health care teams.

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39. Referral Information
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low Demand
Here's how Referral Information is used in Referral Specialist jobs:
  • Utilize computer system to obtain referral information from providers and all electronic medical records are sent to specialists.
  • Provided appropriate referral information to patrons by working with local agencies daily and monitoring local events.
  • Researched missing data elements in referral information to ensure accurate billing information placed within the referral.
  • Provided training, referral information, literature and specific hands-on curriculum ideas to child care providers.
  • Maintain accurate referral records and enter referral information in a database for tracking purposes.
  • Make accurate eligibility determination and provide appropriate referral information to each caller.
  • Load specialty consultation referral information into the computer system.
  • Log incoming referral information into data management system.
  • Communicate referral information to the patient and providers.
  • Determine eligibility and provide appropriate referral information.
  • Enter necessary referral information in database.
  • Communicated all referral information to patient.
  • Organized a referral information database.
  • Cultivated positive relationship with clients, providers, and EAP case managers, directly providing referral information.
  • Approve or deny request based on referral information provided, check for clinical review criteria if applicable.
  • Initial point of contact for individuals and referring physicians seeking to provide referral information for medical care.
  • Input all the referral information that came in via fax, email or phone.
  • Document call, client, and referral information in caller database system.
  • Review referral information, including crisis information and psychosocial history; determined referral to receive mental health services.
  • Inputted all referral information on an Excel spreadsheet for tracking.

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40. High Volume
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low Demand
Here's how High Volume is used in Referral Specialist jobs:
  • Coordinated daily pharmaceutical related matters to verify and expedite a high volume of prescription orders.
  • Managed high volume caseload by processing daily alerts and client information, make changes, updates and adjustments to ongoing cases.
  • Assigned to business unit with high volume of requests and strict deadline for notification of authorization request status.
  • Create and organize high volume of files and audit every entry/change being done to any given case.
  • Received and screened a high volume of internal and external communications, including email and mail.
  • Answered a high volume of calls on a daily basis in queue.
  • Answered high volume of calls regarding basic health information to crisis inquires.
  • Screened and directed high volumes of calls on a 5-line switchboard.
  • Managed Workers Compensation claims in a high volume workers compensation practice.
  • Answered PoconoInfo contacts and met with high volume of walk-ins.
  • Answer high volume incoming calls and assist caller where applicable.
  • Scheduled appointments for a high volume family practice.
  • Maintained a high volume of patients and calls.
  • Processed high volume of outgoing mail.
  • Answered high volume calls 3.
  • receive a high volume of calls in a call center environment and provide information and referrals to community.
  • Create and process an high volume of pathology cases for review for the doctors.
  • Process high volume of medical precertification for radiological and cardiac imaging studies.
  • Key Achievements: Successfully multitasked to manage high volume of responsibilities and complete tasks ahead of schedule.
  • Handled high volume of calls center, telephone communications, including PBX system Track history in ICD-9 coding medical insurances/terminology .

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41. Insurance Authorizations
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low Demand
Here's how Insurance Authorizations is used in Referral Specialist jobs:
  • Assisted patients with referrals to specialists-Obtained insurance authorizations-Called patients regarding appointments-Assisted other office staff-Medical transcription for general office visits and primary care
  • Facilitate direct admissions by coordinating with the Physician, referring facility, Haven Behavioral Senior Care Staff and insurance Authorizations.
  • Coordinated with medical providers to initiate insurance authorizations for medical procedures and tests.
  • Obtain insurance authorizations prior to medical procedures being conducted in clinic.
  • Obtain insurance authorizations and follow-up on referrals by physicians to specialists.
  • Coordinated intakes and referrals to services, obtained insurance authorizations.
  • Obtained medical insurance authorizations for every procedure I scheduled.
  • Processed patient referrals to specialists and obtained insurance authorizations.
  • Call physician offices to obtain records for insurance authorizations.
  • Obtain insurance authorizations for specialist referrals and diagnostic testing.
  • Verify necessary physician referrals and insurance authorizations.
  • Obtained insurance authorizations for testing.
  • Verified insurance authorizations for testing.
  • Maintain accurate and up-to-date logs of the status of referrals and insurance authorizations.
  • Acquire insurance authorizations for procedures and tests ordered by the attending physician.
  • Acquired insurance authorizations for diagnostic testing and out of network office visits.
  • Contacted and secured the insurance authorizations and verifications for such testing procedures.
  • Contacted and securedinsurance authorizations and verifications for such testing procedures.
  • Manage all incoming and outgoing patient referrals Verify patient insurance eligibility/benefits Obtain insurance authorizations/pre-certifications
  • Set up procedures Medication authorization Insurance authorizations Prescription refills Problem solving Vital signs Administered medications ICD-9 coding MA duties

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42. Special Projects
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low Demand
Here's how Special Projects is used in Referral Specialist jobs:
  • Assist in the coordination and implementation of special projects to enhance community relations and program development.
  • Assist Executive Director and Development Director with special projects.
  • Assisted Team Lead with special projects: creating training manuals, power point presentations and also sitting in during interview processes.
  • Performed several special projects for leadership (maintain rosters, assisted when working RIT & placing tickets when needed).
  • Self-managed - be able to make independent decisions on call handling and work independently on special projects.
  • United States I collaborated with doctors and office supervisor on special projects and events.
  • Verified if Insurance was active and worked special projects at manager's request.
  • Based on business needs, asked to take on special projects as requested.
  • Worked on special projects along with various general office duties.
  • Participate in special projects as assigned and train new employees.
  • Assist department with other assignments and special projects.
  • Gather data and review reports for special projects.
  • Participate in special projects assigned by the manager.
  • Assist in special projects and perform other duties assigned
  • Manage various special projects as assigned.
  • Assisted on several special projects.
  • Assist supervisor with special projects.
  • Assist with special projects and other functions as needed to accomplish Child Care Aware of America objectives.
  • Collected co-pays Processed incoming & outgoing mail; Copying, scanning, filing Assisted with special projects as needed.

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43. Clinical Review
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low Demand
Here's how Clinical Review is used in Referral Specialist jobs:
  • Check patient demographics on all new referral patients - Generate letters and create referrals/authorization for clinical review.
  • Facilitated paperwork process and implemented checking process for quality standards for referrals requiring Clinical Review.
  • Referred cases requiring additional clinical review to a Nurse reviewer.
  • Checked eligibility and benefit coverage, correct referral information (ex coding and requested services) prior to clinical review.
  • Identified and referred cases to nurses for clinical review.
  • Screened authorization requests, identifying and referring cases to preauthorization nurses and physicians for additional clinical review.
  • Referred cases to preauthorization nurses for clinical review.

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44. Medical Resources
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45. Telephone Calls
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low Demand
Here's how Telephone Calls is used in Referral Specialist jobs:
  • Coordinated administrative duties including greeting patients, answering telephone calls, maintain patient chart, filed and made copies of documents.
  • Receive telephone calls from consumers, assess callers' needs and give clients referrals to appropriate agencies.
  • Directed telephone calls to various departments as determined by the needs or services requested by customers.
  • Receive telephone calls, transfer calls, and schedule/coordinate appointments for the service members and families.
  • Answer telephone calls from potential clients who are requesting product information.
  • Translated Spanish language telephone calls into English.
  • Control telephone calls in a appropriate and timely manner.

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46. Appropriate Resources
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low Demand
Here's how Appropriate Resources is used in Referral Specialist jobs:
  • Assessed needs of callers and referred to appropriate resources *Recorded required data in online database
  • Redirect customer concerns to appropriate resources.
  • Conduct client intake and give appropriate resources to callers seeking assistance with rent, security deposit, or utilities.
  • Record callers' information into the call center database, and provide referrals to the appropriate resources as needed.
  • Referred Active Duty, National Guard, Army Reserve and their Family members to appropriate resources for services.
  • Assessed client needs and identified appropriate resources available for their unique situation.
  • Access callers need by listening to callers and determining appropriate resources.
  • Receive customer calls, assist and route them to appropriate resources.
  • Provided appropriate resources to callers in need of social services.
  • Identify appropriate resources, and provide enough information.
  • Guide / Refer inbound callers to appropriate resources
  • Worked for a nonprofit agency connecting clients to appropriate resources in the community after assessing psychosocial needs.
  • Identify member needs and facilitate triage to appropriate resources within Humana (i.e.

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47. Financial Assistance
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low Demand
Here's how Financial Assistance is used in Referral Specialist jobs:
  • Assisted counselors in preparing and maintaining financial applications to programs granting emergency financial assistance.
  • Provided consumer education and eligibility screening for those seeking to obtain financial assistance
  • Provide consumer education and eligibility screening for financial assistance.
  • Screened patients to determine eligibility for financial assistance programs.
  • Processed requests for financial assistance.
  • Received incoming calls from the city of Chicago's 311 to assist transient clients, and families requiring financial assistance.
  • Inform patients of the financial assistance program and sending all documentation to the proper department.
  • Interview, screen and complete applications for financial assistance.
  • Process financial assistance applications and maintain accurate database of Goodfellows funds.
  • Provide customers with financial assistance strategies and referrals to other community resources and programs in Broward County.
  • Planned and scheduled healthcare appointments, financial assistance meetings, follow-up appointments, and outreach functions.

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48. HMO
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low Demand
Here's how HMO is used in Referral Specialist jobs:
  • Assist utilization review staff in determination of benefits, eligibility and medical necessity based on HMO policies.
  • Utilize knowledge for medical insurance including managed care, Medicare, Medicaid and HMO S. Maintain patient confidentiality polices.
  • Process and submit medical referrals* Create patient online charts* Request codes for patients next visits* Work with HMO Insurances
  • Process CT, MRI and HMO managed care referral to internal and external medical facilities and specialist.
  • Involved in continue improvement efforts as follow-up to the GE implementation: HMO REFERRAL MODULE.
  • Obtain insurance authorization based on whether the patient has an HMO or PPO plan.
  • Request & handle all referrals & authorizations for HMO insurances & work comp patients.
  • Acted as patient advocate with insurance company and HMO.
  • Processed authorizations through HMO/PPO on a timely manner.
  • Handled various insurances (Medicare, HMO, PPO and - AHCCS).
  • Experience with HMO's, PPO's, Medical, Medicare, CDP.
  • Experience in obtaining referrals from HMO, MEDI-CAL, LIHP and CMS.
  • Worked with the HMO and PPO work queues.
  • Managed all heditis requirements for all HMO managed care plans and coordinating with insurance reps. Diabetes Education one on with patient.
  • Analyze authorizations requests to ensure medical/matrix compliance Obtain process & input medical authorizations from various HMO's & Medicaid.
  • Get authorization for surgical procedures from workers compensation, HMO's, Tri Care Insurance.
  • Provided pediatrics HMO/POS patients with referrals to various healthcare providers.
  • Handle all insurance authorization requests Hmo's.
  • Gain referral authorizations for HMOplans or any policy that requires a authorization for a facility or specialist.
  • Obtain insurance authorizations for patient appointments, including Medicaid GBHC referrals,Tricare Prime authorizations and BCBS HMO referrals.

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49. Effective USE
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low Demand
50. Medical Necessity
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low Demand
Here's how Medical Necessity is used in Referral Specialist jobs:
  • Coordinate outpatient treatment requests with Care Coordination staff for out-of-network providers and Utilization Management team for medical necessity.
  • Respond to provider inquiries and process diagnostic imaging prior authorization requests for medical necessity.
  • Reviewed medical criteria based on each health plans medical guideline for medical necessity.
  • Coordinate outpatient treatment requests with Medical Management team for medical necessity.
  • Provided verbal clinical information or letters of medical necessity when required.
  • Submitted denial and clinical appeals while handling medical necessity/medical review.
  • Researched medical records to prove medical necessity for patients.
  • Utilize approved guidelines to assess for medical necessity.
  • Performed medical necessity review for all 24 hour, urgent, and emergent referrals for accuracy and appropriate diagnosis.
  • Refer patients to specific doctors and or locations depending on their medical necessity.
  • Obtained and edited all Letters of Medical necessity.
  • Type and send out medical necessity letters.
  • Coordinate all aspects of the outpatient/inpatient referral and precertification process including medical necessity, benefits eligibility review, data entry.
  • Input demographic and insurance information for members Screened medical diagnostic test for medical necessity* Provide excellent customer service to every call
  • Evaluate referral and pre-certification requests to determine member eligibility, covered benefits, Network affiliation and medical necessity.
  • Verified predetermination for medical necessity, all plastic surgery and interventional radiology procedures.
  • Utilized internally developed criteria along with Milliman Care guidelines to determine medical necessity.

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Referral Specialist Jobs

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20 Most Common Skills For A Referral Specialist

Process Referrals

28.0%

Insurance Companies

13.6%

Customer Service

7.6%

Medical Records

6.0%

Scheduling Appointments

4.8%

Patient Care

4.7%

Data Entry

4.5%

Phone Calls

4.1%

Crisis Intervention

3.5%

CPT

3.0%

Medicaid

2.7%

Patient Referrals

2.4%

Child Care

2.3%

Physician Offices

2.2%

Mental Health Services

1.9%

Primary Care Services

1.8%

Medical Services

1.8%

Community Resources

1.8%

Appropriate Referrals

1.7%

MRI

1.6%
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Typical Skill-Sets Required For A Referral Specialist

Rank Skill
1 Process Referrals 21.2%
2 Insurance Companies 10.3%
3 Customer Service 5.8%
4 Medical Records 4.6%
5 Scheduling Appointments 3.6%
6 Patient Care 3.5%
7 Data Entry 3.4%
8 Phone Calls 3.1%
9 Crisis Intervention 2.6%
10 CPT 2.2%
11 Medicaid 2.0%
12 Patient Referrals 1.8%
13 Child Care 1.7%
14 Physician Offices 1.7%
15 Mental Health Services 1.4%
16 Primary Care Services 1.4%
17 Medical Services 1.4%
18 Community Resources 1.4%
19 Appropriate Referrals 1.3%
20 MRI 1.2%
21 Patient Demographics 1.2%
22 Front Desk 1.2%
23 Pertinent Information 1.1%
24 Outbound Calls 1.0%
25 Authorization List 1.0%
26 Inpatient Services 1.0%
27 Appropriate Person 0.9%
28 Durable Medical Equipment 0.9%
29 Phone Queues 0.9%
30 EMR 0.9%
31 Computer System 0.9%
32 Clinical Staff 0.9%
33 Hippa 0.9%
34 Hipaa 0.9%
35 Tricare 0.8%
36 Human Service 0.8%
37 Social Workers 0.8%
38 Health Care 0.8%
39 Referral Information 0.7%
40 High Volume 0.7%
41 Insurance Authorizations 0.7%
42 Special Projects 0.6%
43 Clinical Review 0.6%
44 Medical Resources 0.6%
45 Telephone Calls 0.6%
46 Appropriate Resources 0.6%
47 Financial Assistance 0.6%
48 HMO 0.6%
49 Effective USE 0.6%
50 Medical Necessity 0.6%
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12,216 Referral Specialist Jobs

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