Referral Center Specialist

FirstHealth of the Carolinas, Inc.•Hamlet, NC

3d•Onsite

About The Position

FirstHealth of the Carolinas is a nationally recognized health care system located in central North Carolina. Comprised of four hospitals with more than 600 beds, the system also offers leading-edge heart care in the Reid Heart Center, the area’s only dedicated heart and vascular center. Our growing health system has more than 6,200 employees serving in more than 75 locations throughout a 15-county service area. In addition, FirstHealth has received numerous accolades for its patient care and outcomes, including recognitions from Healthgrades, U.S. News & World Report, and Becker's Healthcare. This role requires the ability to cross-train and adapt to electronic medical records in a clinic setting, demonstrating progressive efficiency with this technology. The specialist will answer phones, route calls, and take accurate messages, adapting to phone menus if in use. A sense of urgency related to patient distress is crucial. Responsibilities include scheduling patient appointments with specialty providers, correctly processing referral forms, and transferring patient information. The role involves reviewing insurance to obtain authorizations for diagnostic testing, office visits, and procedures, and providing insurance companies with necessary clinical data for authorization. Effective communication with the clinical team regarding denied authorizations is essential. The specialist will maintain referral records in Epic, ensuring all data fields are completed, and will open and distribute incoming mail. Meeting attendance as required is also part of the role.

Requirements

High school graduate.
Experience with EMR systems
office automation skills
extensive knowledge of CPT and ICD-10 coding and authorizations
strong interpersonal and verbal communication skills
good organizational skills
Is committed to and demonstrates excellent customer service when dealing with all types of customers.

Nice To Haves

1-2 years of medical insurance experience or experience obtaining authorizations and referrals and medical office experience preferred.

Responsibilities

Answers phones, routes calls and or takes accurate message.
Adapts to a phone menu if one is in use.
Demonstrates a sense of urgency relating to patient's level of distress.
Schedules patient appointments with specialty providers including the correct processing of necessary referral forms and transfer of patient information.
Reviews insurance to obtain authorizations for diagnostic testing, office visits, procedures, etc.
Reviews clinical data to provide insurance company with information needed for authorization.
Effectively communicates with the clinical team when an authorization is denied.
Maintains referral record in Epic.
Ensures referral data fields are completed.
Opens and distributes incoming mail to appropriate parties.
Meeting attendance as required.