Referral Specialist

Reporting to the Referral/Authorization Supervisor under direct supervision, the Referral Specialist is responsible for coordinating referral orders for continuation of treatment such as specialty services and diagnostic testing timely and efficiently. The Referral Specialist ensures the patient’s insurance allows them to access services of specialist’s health care provider. These functions include, but are not limited to, obtaining referral and authorizations for patients receiving care at the Dana-Farber Cancer Institute and its partnering facilities, collecting demographic and insurance information, insurance eligibility and benefit verification, where applicable.

Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.

PRIMARY DUTIES AND RESPONSIBILITIES:

With direct supervision, the Referral Specialist:

• Manages referral and authorization information as assigned through daily work queues and documents activities into the hospital information system; may require contacting physician offices and/or payors for referrals and authorizations via phone calls and/or websites.
• Ensures accurate and timely responses to all referral requests.
• Determines the pertinent clinical information needed to send to PCP and/or insurance office for approvals. Coordinates referral requests with PCPs and their practices, specialty practices, and with other clinical consultants as appropriate.
• Engages patients by telephone to discuss referral requests when necessary.
• Verifies insurance eligibility and benefits using automated eligibility systems, payer websites, and calls to the insurance carriers; identify and resolve invalid insurance for patients and/or escalate patients as needed for Financial Counselor intervention.
• Confirms, updates patient demographic, financial, and other relevant personal information into the hospital information system (EPIC)
• Communicates regularly with physicians and other medical providers regarding clinical clarifications for referrals and authorizations, medical necessity requirements, and facilitating conversations with different payers.
• Documents daily activities in a timely, thorough, and accurate manner into the hospital information system.
• Performs other duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:

• Basic knowledge of insurance plans, medical registration, or billing systems.
• Basic knowledge of Epic or other hospital information systems.
• Understanding of the importance of quality in the performance of job functions.
• Customer service and communication skills, both written and verbal.
• Good judgment, tact, and sensitivity.
• Relationship building skills and collaboration.
• Proficient use of Microsoft office.
• Ability to articulate information in a clear, knowledgeable manners to patients, family members, providers, managers, and insurance company representative.
• Ability to work with sensitive patient information and maintain confidentiality.
• Ability to prioritize work and meet pre-determined deadlines, with direct supervision.

MINIMUM JOB QUALIFICATIONS:

Minimum Education:

• High school diploma or GED required; bachelor’s degree preferred.
• 0 years of experience required; 1 year of customer service or hospital/physician office registration experience preferred.

The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate’s relevant experience, skills and qualifications.

For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA).

$41,800.00 - $44,800.00