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Franklin

    Referral Specialist-Remote Position - Franklin, United States - American Health Partners

    American Health Partners
    American Health Partners Franklin, United States

    3 weeks ago

    Default job background
    Full time
    Description

    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 review

    Required Work Experience:

    • Medical assisting and/or medical back office experience strongly preferred.

    Licensing/Certification/Education Requirements:

    • High School or equivalent required
    • Medical Assisting certification preferred

    Other 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
    * eFax


    Physical 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 functions

    Required 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 practices

    Supervisory Responsibilities:

    • Does not have direct supervisory responsibilities
    • Supervisor frequently determines priorities
    • Occasionally needs manager's direction due to extraordinary circumstances
    This position reports to Director of Population Management for TruHealth.
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