Referral Specialist-Full Time-Days

Cape Fear Valley Health

96d

About The Position

The Referral Coordinator at Cape Fear Valley Fayetteville Orthopedics & Sports Medicine is responsible for obtaining and verifying demographic, clinical, financial, and insurance information. This role includes validating medical necessity for Medicare and Non-Medicare cases to ensure clinical and financial clearance. The coordinator will also process signed physician orders/referrals to ensure accurate clinical documentation for care delivery, specialty, and outpatient ancillary referrals. Additionally, the referral coordinator will conduct online insurance eligibility/benefit verification, obtain pre-certification/authorization, referral clearance, and provide financial education on designated cases. The position requires notifying patients, guarantors, specialists, and referring providers with pertinent information, including clinical documentation and referral status.

Requirements

• 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 handle complexity and stress with changing needs of patients, families, visitors, and the Health System.

Nice To Haves

• Flexibility to meet the department hours of operation.
• Ability to communicate orally, see, and hear to collect information.
• Dexterity to operate office equipment.

Responsibilities

• Maintains a working knowledge of processes for medical administrative personnel, including procedures for internal and external referrals.
• Performs insurance eligibility/benefit verification using various mechanisms and ensures authorization matches tests/specialty from referral receipt.
• Validates medical necessity of Medicare and Non-Medicare cases to ensure clinical and financial clearance for services, procedures, or referrals.
• Obtains specialist contact information; prints orders, patient demographics, and provider letters; documents appropriately in electronic health record (EHR).
• Determines proper referral requirements and/or limitations according to requested service, test, or procedure.
• Pre-registers patients for upcoming visits.
• Informs patients/guarantors of their liabilities, including referral approval or denial, and documents appropriately.
• Sends and communicates appointment confirmations to referring offices and calls patients to remind them of appointment details.
• Completes appropriate follow-up protocols as determined by leadership.
• Assists insurance companies, physicians, and hospital departments with patient information in accordance with HIPAA guidelines.
• Meets or exceeds accuracy standard goals determined by Patient Access Leadership.
• Performs other duties as assigned.

Benefits

• Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity.
• Commitment to integrity, patient-centeredness, and excellence throughout the healthcare process.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees