Referral Specialist - Brookings

Under general supervision from the Patient Contact Center Supervisor, the Referral Specialist's primary function is the coordination, processing and scheduling of medical referrals and prior authorizations for a variety of medical services/procedures for patients as requested by medical providers. Referral and Authorization Specialist will collaborate with other referral staff, medical providers, nursing staff and other patient care support staff.

Essential Functions:
Responsible for obtaining managed care authorizations and verifying patient insurance benefits. Prepare reports and statistical data when requested.

• Gathers pertinent information as needed via EHR or from clinical team to accurately complete referral and authorization process. Review details and expectations about the referral and authorization with patients.
• Monitors electronic health record (EHR) notifications throughout the day to capture referral and authorization requests in real time.
• Respond to in-house provider questions, requests and concerns regarding the status of patient referrals or authorization, care coordination or follow-up status.
• Fax referral form to providers that do not require any records to be sent. For primary patient visits, fax referral form and print requested records that are obtained.
• When claims are denied, the referral and authorization specialist is responsible for reviewing the claim details and pursuing action as warranted.
• Other duties as assigned to support the overall effectiveness of the department and organizational performance in accordance with Curry Health Network's Mission, Vision and Shared Values.

Minimum Education & Experience:
High School diploma or equivalent is required.

• Two years' experience in a clinic setting preferred.

Required Knowledge, Skills & Abilities:
Able to treat patients, providers and co-workers with dignity & respect at all times.

• Knowledge of the medical clinic purpose and operations.
• Ability to prioritize duties, perform them efficiently and adjust to and accept the unexpected.
• Excellent written and verbal communication skills, telephone manners and proper telephone etiquette are required
• Knowledge of medical terminology; knowledge of various insurance plans such as Medicaid, Medicare and private insurances.
• Skills in using medical databases; CPSI-EHR systems.
• Proficient using computer software incl. Microsoft Office: Word, Excel, Outlook.

Curry Health Network (a dba of Curry Health District) is comprised of a hospital and several medical clinics located on the southern Oregon coast. Curry Health Network is an Oregon special health district, a form of local government and municipal corporation that has been granted 501(c)(3) status by the Internal Revenue Service, and as such, has the exemptions and rights that such status affords.

Curry General Hospital in Gold Beach, a critical access hospital and the sole hospital in Curry County, is your community hospital and Curry Medical Practice offers primary and specialty care and is located within the hospital. Curry Medical Center in Brookings offers primary, specialty and same day care services in addition to 24/7 emergency department services. Primary care services are also available at Curry Family Medical, our medical clinic which serves Port Orford. Curry Health Network is committed to providing high quality health care with service excellence, close to home.

Equal Opportunity Employer: Curry Health Network shall not discriminate against any employees or applicants for employment or financial programs on the basis of race, religion, color, sex (including pregnancy, gender identity and sexual orientation), parental status, national origin, marital status, age, physical or mental disability, family medical history or genetic information, political affiliation, military service, or any other category protected by federal, state or local laws.

Additional Information
Position Type : Full Time
Shift : Day