Referral Specialist - Mount Carmel Medical Group - Westerville - Neuro
Mount Carmel Health System

Westerville, Ohio

Posted in Medical and Nursing

Job Info

Employment Type:
Full time


Why Mount Carmel?

With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan, and extensive outreach and community wellness programs, Mount Carmel Health System serves more than a million patients in central Ohio each year, and we've been a pillar of this community for more than 130 years. As a proud member of Trinity Health, one of the nation's largest Catholic healthcare delivery systems, our network of caring spans 22 states, 94 hospitals, and 133,000 colleagues nationwide.

We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing.

What we offer:

  • Competitive compensation and benefits packages including medical, dental, and vision coverage
  • Retirement savings account with employer match starting on day one
  • Generous paid time off programs
  • Employee recognition incentive program
  • Tuition/professional development reimbursement
  • Relocation assistance (geographic restrictions apply)
  • Discounted tuition and enrollment opportunities' at the Mount Carmel College of Nursing

Why Columbus?

The nation's 14th largest city, Columbus, Ohio is one of the fastest growing major metropolitan areas in the Midwest - ranked #1 for population growth, #1 for job growth, #1 for wage growth, and #1 real estate market. And with a vibrant blend of professional sports, world-class attractions, creative cuisines, and a flourishing music and arts scene, you'll never be found wanting for entertainment and experiences to call your own in Columbus. Learn more at!

About the job:

The Referral Specialist coordinates, maintains, confirms and/or secures referrals, authorizations, or precertification's needed on physician/clinic services. Verifies the accuracy and completeness of admitting information on outpatient referrals and obtains authorizations when needed. Also maintains and keeps updated referral logs.

What you will Do:
  • Contacts insurance carriers after verifying information to secure benefit coverage, policy limitations, pre-certification, etc. for customers.
  • Conducts follow-up calls as necessary to physician offices, patients, and third party payers to complete pre-certification process.
  • Contacts relevant internal staff to update status, coordinate resolution/correction of issues, sends records to insurance companies and determines whether a denied authorization should be appealed.
  • Educates internal and external customers regarding referral/prior authorization requirements, eligibility guidelines, documentation requirements, and insurance procedures.
  • Maintains reference materials as they pertain to insurance carrier procedures.

What we are looking for:
  • High School diploma or equivalent required
  • One year of experience in a similar position in a medical office preferred.
  • Knowledge of medical terminology and medical office procedures preferred.
  • Knowledge of third party payers and pre-authorization requirements preferred.
  • Basic computer skills required
  • Effective Communication Skills

Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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