REFERRAL & PRECERT SPEC

Covenant Health•Morristown, TN

2d•Onsite

About The Position

The Referral & Pre-Certification Specialist at Knoxville Heart Group - Morristown, a part of Covenant Medical Group, is responsible for directing the daily operation of scheduling for inpatient/outpatient procedures and services. This role ensures that all necessary referrals or pre-certifications are obtained. Covenant Medical Group is the employed and managed medical practice organization of Covenant Health, providing comprehensive care across East Tennessee with over 300 physicians and advanced practice providers in 20 communities. They are committed to offering coordinated, patient-centered care across the health continuum.

Requirements

Medical terminology knowledge required.

Nice To Haves

Preference may be given to individuals possessing a HS diploma or GED.

Responsibilities

Schedules inpatient/outpatient tests, procedures and appointments as directed by provider. Documents each scheduled event in detail in the medical record file.
Accurately completes all forms required for referrals and pre-certifications.
Maintains knowledge of requirements and guidelines as mandated by insurance plans, hospitals and outpatient facilities.
Maintains accurate testing, referral and appointment logs with follow-up verification in the referral tracking database.
Maintains knowledge of ICD-9 and 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.
Reports any problems obtaining referrals, pre-certifications or appointments as ordered by the provider.
Collaborates with the patient, physician and other care team members as part of a team based approach to overall patient care.
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.