Referral Specialist-Remote
: Job Details :

The purpose of this position is to provide specialist referral authorization submission and follow up support for field clinician teams. With potential to add submission of other types of authorizations and miscellaneous medical practice support as needed.ESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation.* The referral specialist will receive authorization requests from the clinical team* The referral specialist will collect the needed information to complete the authorization request including clinical data retrieved from an EMR or specialist practice and submit the authorization request to the health plan team.* The referral specialist may review in-network and non-par provider lists as well as local maps to determine the appropriate specialist for referral.* The referral specialist will systematically track the requests submitted and follow up with clinicians upon completion.Required Skills:* Communication skills and active listening via telephone conversations with clinicians and health plan staff* Be able to manage multiple tasks and input from various sources* Be able to organize and prioritize work for completion and follow up* Proficiency with medical terminology* Able to organize and communicate effectively via email* To have familiarity with ICD-10 and CPT codes* Great telephonic and customer service skills* Gather clinical data for reviewRequired Work Experience:* Medical assisting and/or medical back office experience strongly preferred.Licensing/Certification/Education Requirements:* High School or equivalent required* Medical Assisting certification preferredOther Requirements:* Self-starter needed and potential for work from home option if productivity demonstrated.Required Computer Software/Equipment Used:* Microsoft Office including Outlook, Excel and Word* Basic EMR* Standard Office Equipment* Computer* eFaxPhysical Requirements:* Work is typically performed in a standard office environment; well-lit; comfortable temperature controlled; above-average conversational noise is frequent* Most days will be spent interfacing with a computer screen.* The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functionsRequired Safety Expectations:* Working safely and follow safety rules* Report unsafe working conditions and behaviors* Take reasonable and prudent actions to prevent others from engaging in unsafe practicesSupervisory Responsibilities:* Does not have direct supervisory responsibilities* Supervisor frequently determines priorities* Occasionally needs manager's direction due to extraordinary circumstancesThis position reports to Director of Population Management for TruHealth.