[Hiring] Referral Specialist @Orchid Health

Role Description

Join an Organization that Puts its People First! This is a remote position with a schedule of Monday - Friday (8am - 5pm) - hours can be flexible.

The Referral Specialist is one of the most important roles at Orchid Health. The Referral Specialist receives and documents patient referrals and follows Orchid Health’s referral process. Responsibilities include:

• Ensure appropriate appointments and follow-up appointments in the clinic following referral requests/visits.
• Ensure documentation from specialists/offices is obtained, filed in the chart, and forwarded to companies/payers as appropriate.
• Perform patient registration tasks and procedures as requested and assist in the clinical area as trained and requested.
• Initiate all referral requests within 24-48 hours on business days.
• Return all calls promptly, generally within the same day.
• Document all stages of the referral process within the EMR program (Athena) and communicate to the appropriate people regarding injury cases.
• Coordinate and schedule specialty exams within the clinic as necessary.
• Obtain and/or document approvals from Third-Party Payers for payment for services as directed or indicated via protocols.
• Answer phone calls and act as a liaison between companies, patients, attorneys, and work comp insurance companies.
• Request any missing documentation from providers, once received and signed off by the medical director, scan appropriate information into the EMR program (Athena).
• Resolve pre-certification, registration, and case-related concerns prior to a patient's appointment.
• Gather pertinent information from insurance carriers, financial counselors, and other ancillary staff to ensure the patient is not financially obligated for services provided.
• Use the EHR (Athena) to monitor referral orders and document all referral activities in the EHR.
• Complete prior authorizations when needed.
• Complete appropriate referral forms.
• Consult with providers regarding specific diagnosis information, as it relates to the referral.
• Comply with federal, state, and local regulations regarding patient confidentiality and HIPAA.
• Ensure that the patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits, and community organization related to their health.
• Perform other job-related duties, as may be assigned.

Qualifications

• High school diploma or GED certificate.
• Minimum of 1 year relevant healthcare experience.
• Proficient at Excel, Word, and Outlook.
• Excellent communication and problem-solving skills.
• Excellent interpersonal skills, empathy, and tact when dealing with insurance companies, patients, and other health care facilities.
• Able to assume the responsibilities delegated by the Manager to provide efficient and effective coordination of care.
• Willing to adapt to changing situations and circumstances.

Requirements

• Bilingual in Spanish (preferred).
• Athena experience (preferred).
• Knowledge of medical terminology (preferred).

Benefits

• Medical, Dental, & Vision – Orchid pays monthly premiums at 100% for team members and at least 50% for their dependents for base medical and dental plans.
• $1,000/year Wellness Benefit - for things that make you happy!
• 401(k) with a company match and financial planning and wellness resources available at no cost.
• A Continuing Education / Continuing Medical Education budget for all team members.
• An Employee Assistance Program (EAP) that provides mental health support, financial planning, and lifestyle training opportunities, at no cost to employees.
• 128 hours of PTO per year, annually front-loaded with tenure-based increases.
• 40 hours of paid inclement weather and emergency closure leave, annually front-loaded.
• 8 paid holidays, plus your birthday off!
• Free care at our clinics for team members and their families.
• And more!