Under close supervision, the Referral Specialist I is responsible for gathering and maintaining patient demographic and financial information when necessary and reviews outstanding referral requests. Referral team is responsible for documenting insurance information provided by PCP/patient accurately and timely. Referral team verifies and obtains additional clinical information and insurance authorizations/referrals, and communicates directly with PCP to obtain required insurance referrals prior to scheduled appointments. If insurance referral is missing and/or prior authorization is required for a procedure/test, referral staff must route to the authorization team. The Referral Specialist I is expected to meet Key Performance Indicators (KPI), quality metrics, and to uphold a culture of continuous improvement.
Process referrals from internal providers and routes referrals in a timely manner to the authorization team to obtain necessary authorization information from insurance company and document in IDX/Epic
Process external physician practice referrals; if referral requires insurance authorization the primary care practice obtains authorization from primary care provider insurance companies and all necessary information will be added to the referral work queue
Documents referral and authorization/insurance information in IDX/Epic
Enters completed referrals with authorization numbers into referral work queue required fields
Meets standard Key Performance Indicators and quality metrics
Contact patients to schedule appointments
Assists in education and acts as a resource to clinicians and support staff regarding authorizations
Performs other duties as assigned
Knowledge, Skills, and Abilities
Knowledge of medical terminology and procedures
Processes referrals for all centralized specialties
Strong written and verbal communication skills
Interpersonal/human relations and customer service skills
Ability to maintain confidentiality
Strong computer knowledge and skills
Ability to change priorities regularly and multi-task
Strong attention to detail and accuracy
Adheres to all University and SLUCare policies, procedures, and protocols
Upholds the SLUCare Mission, Vision, and Values and Cura standards
High School Diploma or equivalent; supplemented with one to two (1-2) years healthcare related experience. Experience with insurance authorizations or referrals preferred. An equivalent combination of education and experience will be considered.
Saint Louis University(SLU) is a private, co-educational Jesuit university located in St. Louis, Missouri, United States. Founded in 1818 by the Most Reverend Louis Guillaume Valentin Dubourg SLU is the oldest university west of the Mississippi River. The University has campuses in St. Louis, Mo. and Madrid, Spain. SLU values academic excellence, life-changing research, compassionate health care, and a strong commitment to faith and service. For nearly 200 years, the University has gone beyond teaching facts and figures, encouraging students to form ideas and identities. Today, SLU students are nearly 14,000 strong. The University has invested vast resources to advance academic programs and enhance the student experience. SLU also is a major research institution where premier researchers tackle local and global challenges. And the University's commitment to community service has earned it national acclaim and bolstered its status as a character-building college.