Medical Referrals Specialist

2 days ago

Cebu City P, Philippines Virtual Staffing Solutions Full time $30,000 - $60,000 per year
Description

Virtual Staffing Solutions is currently looking for Medical Referrals Specialists to join our growing healthcare support team. In this role, you will play a key part in managing patient referrals by verifying insurance coverage, securing authorizations, and ensuring that all referral-related documentation is accurate and complete. You will help ensure patients receive timely access to the care they need while supporting efficient billing and claims processing.

Key Responsibilities
  • Obtains and processes referrals from providers and communicates authorizations with patients (via phone & mail) and medical staff in a timely manner.
  • Prepares, processes, and completes referrals accurately and in a timely manner, including urgent and stat referrals for assigned members.
  • Tracks referrals in the electronic medical records (EMR) system; Follows up on submitted authorization requests and maintains consistent status updates via EMR.
  • Monitors and reports on status of authorization requests; escalates issues as necessary until fully resolved and the referral loop is closed.
  • Communicates referral and authorization information and pertinent medical information to the patient and specialty providers.
  • Manages the need for redirection across all clients and payers by working with clinical teams to ensure the timeliness of re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care.
  • Reviews consultation reports for needed follow-up requests and works with providers to ensure timely processing of all follow-ups.
  • Works with the health information (medical records) department to ensure timely retrieval of consultation reports.
  • Assists the patient with scheduling appointments with the specialist, should the patient express any challenges in accomplishing this themselves.
  • Submits retro-authorizations and distinguishes between primary care and internal specialty visits.
Skills, Knowledge & Expertise
  • Minimum of 1 year BPO experience in US Medical Billing or a related field
  • Strong knowledge of US billing, collections, coding, and healthcare regulations
  • Experience in assigning ICD-10 and CPT codes is an advantage
  • Excellent written and verbal communication skills
About Virtual Staffing Solutions

We specialize in delivering innovative solutions and exceptional services to meet the diverse needs of our clients. With a strong commitment to quality and customer satisfaction, we strive to exceed expectations and drive success in every project we undertake.

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