CLIN REFERRAL SPEC II
About The Position
The Clinical Referral Specialist manages scheduling for specialty facilities and procedures, creates and registers new patient charts, verifies addresses, and submits insurance eligibility. The specialist prioritizes orders, obtains pre-certifications, and follows up on referrals and authorizations to support timely patient care. The role collaborates with patients, providers, and nursing staff as part of a team-based approach to patient care. Covenant Medical Group is the employed and managed medical practice organization of Covenant Health, providing comprehensive care across East Tennessee. With more than 300 physicians and advanced practice providers in 20 communities, it offers services across primary care, walk-in clinics, preventive medicine, and advanced surgical and subspecialty services. The organization is committed to coordinated, patient-centered care and access to providers close to home.
Requirements
- One to two years of experience in referrals and diagnostics, including pre-certification experience.
- Knowledge of medical terminology.
- Knowledge of ICD-10 and CPT coding.
- Basic computer skills.
- Education and/or prior work experience sufficient to demonstrate the knowledge, skills, and abilities needed to perform the essential tasks; typically equivalent to a high school diploma or GED.
Nice To Haves
- Bachelor’s degree in a directly related field from an accredited college or university.
Responsibilities
- Schedule inpatient and outpatient tests, procedures, and appointments as directed by the provider, and document each event in detail in the medical record.
- Complete all forms required for referrals and pre-certifications accurately.
- Obtain authorizations from patients’ insurance providers and add them to the electronic health record.
- Apply knowledge of requirements and guidelines mandated by insurance plans, hospitals, outpatient facilities, and ambulatory practices.
- Maintain accurate testing, referral, and appointment logs, including follow-up verification in the Referral/Diagnostic tracking database.
- Coordinate the date, time, and location of procedures and appointments with patients, facilities, and providers.
- Communicate appointments and any special instructions regarding scheduled procedures or appointments to patients.
- For external referrals, verify whether the receiving practice will contact the patient; if not, communicate appointment information by phone, text, patient portal, and/or USPS mail.
- Report problems obtaining referrals, pre-certifications, or appointments as ordered by the provider.
- Collaborate with patients, physicians, and other care team members as part of a team-based approach to patient care.
- Assist with orientation and education of the Centralized Referral team.
- Assist in developing and maintaining departmental training manuals and workflow documents.
- Provide support and assistance to employees.
- Professionally consult with patients, providers, and hospital staff regarding appointment scheduling and pre-registration.
- Attend required meetings and participate on committees as directed.
- Follow policies, procedures, and safety standards; complete annual required education assignments; work toward goals and objectives; and participate in quality improvement initiatives as requested.
- Perform other duties as assigned.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
