Referral Specialist-Per Diem

Referral Specialist-Per Diem-Variable at Cape Fear Valley Health

Location
:
Fayetteville, North Carolina

Responsible for obtaining and verifying demographic, clinical, financial, and insurance information. Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Processes signed physician orders/referrals to ensure accurate clinical documentation for care delivery, specialty and outpatient ancillary referrals. Conducts online insurance eligibility/benefit verification, obtains pre-certification/authorization, referral clearance, and provides financial education on designated cases. Notifies patient/guarantor, specialist, referring provider, etc.,

with pertinent information, inclusive of clinical documentation, referral status, follow-up, etc.

• Maintain a working knowledge of medical administrative processes, including internal and external referral procedures.
• Perform insurance eligibility/benefit verification and ensure authorization matches test(s)/specialty from referral receipt.
• Validate medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.
• Obtain specialist contact information; print orders, patient demographic, and provider letter; document as appropriate in electronic health record (EHR).
• Determine proper referral requirements and/or limitations according to requested service, test, or procedure, including identification of emergent referrals.
• Pre-register the patient for upcoming visit(s).
• Inform patient/guarantor of liabilities, referral approval or denial, and document appropriately.
• Send and/or communicate appointment confirmation to referring office; call the patient to remind of appointment date, time, location, and preparation for procedures following protocols.
• Complete follow-up protocols as determined by leadership, including routine and urgent referrals (initiation to completion).
• Assist insurance companies, physician and physician practices, and hospital departments with patient information in accordance with HIPAA guidelines.
• Meet or exceed accuracy standard goal determined by Patient Access Leadership.
• Other duties as assigned.

• Registered or Certified Medical Office Assistant or 2-4 years of direct referral experience in lieu of certification.
• Licensed Practical Nurse background preferred.
• Medical Terminology required.
• 2-4 years insurance/referral experience within a hospital or medical office setting preferred.
• Pass pre-employment testing and post-training testing.
• Pass and maintain the Certified Healthcare Access Associate (CHAA) exam within one year of employment.
• Knowledge of insurance and collection of payments.
• Experience with Microsoft software.
• Excellent verbal and written communication skills, customer service skills and problem solving abilities.
• Ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System.
• May be required to periodically rotate shifts and regular days off.
• Flexibility to meet the department hours of operation.

• Ability to communicate orally, see, and hear to collect information.
• Dexterity to operate office equipment.
• Subject to eye strain due to hours spent looking at a monitor screen.
• Noise level is low to moderate.
• Answers telephone calls.
• Uses computer and other business machines extensively.
• Bends, reaches, pushes, and pulls file drawers to file records and reports.
• Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds, and occasionally lift or move up to 50 pounds.

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity