Referral Specialist

Emerging Therapy Solutions (ETS) is looking for a Referral Specialist to support timely and successful processing of ETS client member referrals. In this role, you will be responsible for working closely with clients to obtain the information needed to process and monitor referrals. In addition, you will respond to client inquiries for contracted rates and facility information, provide referral management support, interact with healthcare providers by phone and email, and facilitate successful completion of client and provider agreements and contracts as needed.

The Referral Specialist is part of the referral team and will work closely with a variety of other departments, including the clinical team, contracting, operations, and with client engagement representatives to support the needs of ETS clients related to network access and rate requests, and to support successful referral processing that will result in optimal claims repricing. The Referral Specialist role is a hybrid role – ideally coming to the office at least one day a week or as needed.

About Emerging Therapy Solutions (ETS)Join the team that empowers access to revolutionary cell and gene therapies! Industry veterans of managed care solutions, healthcare biotech, and transplant created Emerging Therapy Solutions® (ETS) in 2018 to help healthcare payers – including reinsurance and stop-loss payers, health plans and self-funded employers – manage the risks associated with high-cost therapies for rare and complex conditions.

ETS provides trusted insights, expert support and comprehensive services to healthcare payers and related stakeholders, helping them prepare for rapidly expanding growth and costs for available and coming advancements in cell and gene therapies and other specialty treatments.

We benefit our clients through our high-touch service, industry expertise, and our comprehensive suite of services, including our knowledge center educational content, our forecast modeling tools and consultation, and network access and negotiated rates for care. Our number one priority is building client relationships that add value and benefit our clients!

Located in Minneapolis, Minnesota across from the Mall of America, ETS has been growing our team since its inception, including acquiring transplant management expert LifeTrac in 2021. For more information, visit: www.emergingtherapies.com.

About YouYou are organized, detail-oriented and persistent, second only to your professionalism and efficiency. You enjoy seeing tasks through to completion and to closing the loop, especially as you make it possible for clients to receive timely services supported by regular communications updates at each milestone. You are a problem-solver and look for the win-win, while doing the ‘right thing’. You are skilled in preparing clear messages and communications with business contacts. You are comfortable helping to improve or establish new processes and then thrive following these processes to complete your work. You are excited to contribute to a fast-paced and energetic business and industry. You are flexible, and can balance working independently, yet being part of a team – as well as ideally working in the office part of each week and remotely for the rest.

Your day-to-day duties will include providing support for referral management by processing incoming referrals, initiating update requests to providers by phone and email, and maintaining data integrity within the designated systems and within the realm of duties associated with referral support. Regular responsibilities also include gathering and reviewing case-related claim and savings data to monitor referrals through the continuum, promoting effective communication and workflows between departments, and making recommendations to improve current processes. As part of the client delivery services team, you will work closely with other ETS teams to support our clients and other stakeholders, and will report to our SVP, Client Delivery Services.

Main ResponsibilitiesProcess incoming patient referrals in a timely manner and based on expectations, including ensuring that the required patient and status information is obtained from and provided to the client and/or facility.For existing patient referrals, through the ongoing client and/or facility contacts, gather additional information pertinent to the referral at the cadence defined in company procedures, through to case closure. Document this information quickly and accurately in designated systems.Facilitate the smooth acquisition and successful completion of referrals by providing timely, friendly, and excellent service to ETS clients with their referral, rate/contract, and patient-specific questions, and include their clinical staff on any clinically-related questions.Protect client information and ETS database credibility by maintaining information accurately and thoroughly, following company procedures, including routinely monitoring and addressing any errors, anomalies or data duplications created by staff or clients.Follow all procedures to maintain integrity and security of protected health information.Maintain response time expectations for follow-up on all requests, meeting company expectations, including for referral inquiries, timely and thorough documentation of communications, client follow-up, and any other client communications.Follow all company Private Health Information (PHI) policies.Back up referral team members as needed, staying current on each role's main daily duties.Other duties as requested.

QualificationsHigh school diploma or GED required. An associate or bachelor’s degree is a plus.3 – 5 years related healthcare work experience required, with a good understanding of third-party reimbursement procedures, experience working with insurance companies in revenue cycle, and/or experience working with commercial and governmental insurance plans.Transplant experience preferred.

Required Knowledge, Skills and AbilitiesExceptional communications skills, particularly with a proven ability to express thoughts and ideas verbally and in writing, and to exhibit good listening skills and comprehension, and with demonstrated ability to write clearly and effectively.Excellent attention to detail, accuracy, and quality.Highly organized, with ability to multi-task and work effectively in a fast-paced, professional environment with multiple and changing priorities.Knowledge of insurance terminology, plan types, medical terminology, and clinical documentation review are preferred.Self-starter that can take initiative and works well independently, working with customer-first mindset.Proficiency with Outlook, Microsoft Teams and Microsoft Office 365 products.Operates with high integrity, including treating others with respect, keeping commitments, working well with others, and upholding organization values and principles. Benefits: We value our employees’ time and efforts. Our commitment to your success is enhanced by our competitive compensation and an extensive benefits package including paid time off, medical, dental and vision benefits and future growth opportunities within the company. Plus, we work to maintain the best possible environment for our employees, where people can learn and grow with the company. We strive to provide a collaborative, creative environment where each person feels encouraged to contribute to our processes, decisions, planning and culture. To Apply: To respond to this opportunity, please email your resume to: sara.hakanson@emergingtherapies.com We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.