Position Title:    Referrals and Eligibility Specialist

Supervisor:         Patient Access Manager

FLSA Status:       Non-Exempt

Mission:

To provide our patients and community the most innovative and breakthrough treatment options to improve overall health and wellness.

Values:

Patient Experience

Innovation

Integrity

Teamwork

Job Summary:

The Referrals and Eligibility Specialist is responsible for coordinating and supporting a wide range of clinical and administrative functions, including patient scheduling, insurance verification, and referral management. This role ensures efficient clinic operations and a seamless patient experience by managing eligibility processes, authorizations, and communication with patients, providers, and insurance entities.

Key Responsibilities

• Schedule new patient appointments and accurately enter information into the electronic scheduling system.
• Verify insurance eligibility and benefits for clinic and surgical services to ensure coverage is active and billable.
• Assist patients with insurance-related inquiries and correspondence.
• Obtain and verify required referrals and prior authorizations.
• Investigate and resolve insurance and benefit discrepancies.
• Communicate effectively with referring providers and clinics.
• Coordinate the collection of medical records prior to patient consultations.
• Collaborate with workers’ compensation representatives and auto insurance adjusters to secure necessary authorizations.
• Ensure timely progression from referral receipt to initial patient consultation.
• Maintain compliance with organizational policies and HIPAA regulations to protect patient confidentiality.
• Perform additional duties and responsibilities as assigned.

Supervisory Responsibility:

This position has no supervisory responsibilities.

Qualifications:

• High School Diploma or GED required. Bachelor’s Degree preferred.
• Minimum of one year of proven strong customer service, scheduling, and phone skills required.
• Minimum of one year of healthcare office experience with insurance eligibility required.

Skills & Abilities:

• Good writing, analytical, and problem-solving skills.
• Exceptional ability to listen and communicate to others.
• Ability to prioritize duties.
• Ability to follow oral and written instructions.
• Ability to operate standard office equipment.
• Strong computer skills.
• Ability to work well whether independently or as part of a team.
• Knowledge of principles and practices of basic office management and organization.

Work Environment:

While performing the duties of this job, the employee regularly works in an office setting. This is not a remote job!

Physical Demands:

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:

While performing the duties of this job, the employee is occasionally required to walk; sit; use hands to grasp or handle objects, tools, or controls; reach with hands and arms; stoop, kneel, or crouch; talk or hear. The employee must occasionally lift or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Compensation & Work Schedule:

• Full-time: 40 hours/week.
• Non-Exempt.
• Day Shift: Monday - Friday.
• No evenings or weekends.
• A competitive benefits package including medical, dental, vision, disability, and life insurance, 401(k) plan, PTO time, paid holidays, and HSA plan is offered.

No Phone Calls, Please!

All applicants must be legally authorized to work in the United States at the time of hire. Twin Cities Pain Clinic does not provide employment visa sponsorship for this position.

JOB CODE: 1000247