Referral Specialist

Overview

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• Collects comprehensive detailed patient medical information, determining the need for nursing intervention and expediting care for those deemed urgent, interpreting and applying policies and procedures, providing financial education to customers regarding benefits to assist in their understanding of personal financial liability, and obtaining insurance verification and pre-certification.
• Coordinates single case agreements and third party payer contracts, schedules appointments, tests and intervenes across multiple departments, clinics, and private medical offices.
• Coordinates medical information, records and films for upcoming appointments. Communicates patient status with internal and external providers. Answers patient phone calls and addresses concerns and needs.
• Captures complete and accurate patient information for medical triage of all spine referrals, demonstrates understanding and skill in use of the Cordata software and of practice and physician protocols.
• Effectively identifies and processes urgent patients; identifies patients requiring pre-certification or pre-authorization at the time outpatient services are requested.
• Obtains external medical records and transfers them to HIM and Cordata for medical review.
• Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing. Contacts pre-certification/insurance company to determine eligibility and benefits for requested services, as applicable.
• Advises the patient, referring physician, insurance company or provider of insurance coverage issues and customer financial responsibility.
• Obtains Workers Compensation authorization through the physician of record and assists in completion of appropriate paperwork and documents authorization/certification numbers in the registration/billing systems and Cordata.
• Refer WVU Cares / self-pay patients to the financial counselor to determine eligibility, and to resolve questions regarding payment for treatment.
• Using Epic, schedules clinic appointments with appropriate department as recommended; communicates appointment date/time, directions and pre-procedure instructions with patient.
• Flags patient accounts for special notifications and informs clinic of necessary assistive devices for appointment; explains insurance and payment requirements to patient.
• Receives, responds and attempts to resolve patient and referring physician/office needs and complaints appropriately and in a timely manner.
• Accurately moves patients through all stages of medical triage in Cordata system to ensure appropriate and timely care; communicates patient needs and flow through the medical triage process via letter or Epic messages.
• Accurately records referring physician/office information in Cordata and submits updates/corrections to the Referring Physician Database via Ruby-on-Line as appropriate; identifies duplicate Epic files and addresses issue with HIM.
• Participates in performance improvement and educational programs to meet mandatory requirements and identified needs with regard to job and personal growth; attends departmental meetings and/or documents review of meeting minutes.

MINIMUM QUALIFICATIONS

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• High School or Equivalent

EXPERIENCE:

• Two years of clinical or customer service experience

PREFERRED QUALIFICATIONS:

• Three years of experience with direct customer service

• Frequent walking, sitting, stooping, reaching, pushing, pulling, lifting, grasping and feeling are necessary body movements utilized in performing duties throughout the work shift
• Must be able to sit for extended periods of time
• Must have reading and comprehension ability
• Visual acuity must be within normal range
• Must be able to communicate effectively
• Must be able to exert in excess of 50 pounds of force…