ReferralSpecialist

_We 're committed to bringing passion and customer focus to the business._ **Job Description:** We are excited to welcome a dedicated and professional referral specialist to our team! This role is all about providing exceptional care coordination, appointment scheduling, and member advocacy while also managing internal referral processes and obtaining necessary authorizations. If you have a strong background in customer service and healthcare and thrive in a dynamic environment, we would love to hear from you! **Job location** In the Office (McAllen, TX) area, for the first 90 days upon hire date, later, job performance will be evaluated for the possibility of remote work from home. **Objectives** * Streamline care coordination between members and providers. * Utilize community resources effectively to meet member needs. * Enhance appropriate utilization of services and preferred providers for medical care. * Maintain high standards of confidentiality and compliance with HIPAA regulations. **Job Responsibilities** * Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. This tracking may use an IT database. * Ensure complete and accurate registration, including patient demographic and current insurance information. * Assemble information concerning the patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to the specialist. * Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, and prognosis. Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians. * Review details and expectations about the referral with patients. * Assist patients in problem-solving potential issues related to the health care system, and financial or social barriers (e.g., request interpreters as appr