CLIN REFERRAL SPEC II

Covenant Health•Knoxville, TN

1d•Onsite

About The Position

The Referral and Precertification Specialists manages scheduling for specialty facilities and procedures, creates and registers new patient charts, verifies addresses, and submits insurance eligibility. They prioritize orders, obtain pre-certifications and follow up on referrals and authorizations to ensure timely patient care. The specialist collaborates with patients, providers, and nursing staff to ensure a team-based approach to patient care.

Requirements

One (1) to two (2) years’ experience in Referrals and Diagnostics with pre-certification experience.
Medical terminology knowledge a must.

Nice To Haves

Bachelor’s degree in a directly related field from an accredited college or university.

Responsibilities

Schedule inpatient/outpatient tests, procedures, and appointments as directed by provider. Documents each event in detail in the medical record.
Accurately completes all forms required for referrals and pre-certifications (authorizations).
Authorizations are obtained from the patient’s insurance and added to the electronic health record.
Knowledge of requirements and guidelines as mandated by insurance plans, hospitals, outpatient facilities, and ambulatory practices.
Maintains accurate testing, referral, and appointment logs with follow-up verification in the Referral/Diagnostic tracking database.
Knowledge of ICD-10, CPT Coding, and basic computer skills.
Coordinates date, time, and location of procedure/appointment with the patient, facility, and provider.
Communicates appointments as well as special instructions regarding scheduled procedure/appointment with the patient.
For Internal Referrals, the patient will be notified of an appointment by the provider’s practice receiving the referral.
For External Referrals, the office staff will verify whether the practice receiving the referral will contact the patient regarding appointment information. If they will not then CMG staff will communicate appointment information to the patient by phone, text, patient portal, and/or USPS mail.
Report any problems obtaining referrals, pre-certifications or appointments as ordered by the provider.
Collaborate with the patient, physician, and other care team members as part of a team-based approach to overall patient care.
Assists in the orientation and education of Centralized Referral team.
Assists in the development and maintenance of departmental training manuals and workflow documents.
Provides support and assistance for employees.
Professionally consults with patients, providers, and hospital staff members regarding the scheduling and pre-registration of appointments.
Attends meetings as required and participates on committees as directed.
Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
Performs other duties as assigned.