Referral Specialist-Full Time-Days

Cape Fear Valley Health • Fayetteville, NC

4d • Onsite

About The Position

The Referral Specialist obtains and/or verifies demographic, clinical, financial, and insurance information. This role validates the medical necessity of Medicare and Non-Medicare cases to ensure clinical and financial clearance. The specialist obtains and processes signed physician orders/referrals for accurate clinical documentation for care delivery, specialty, and outpatient ancillary referrals. Additionally, the referral coordinator conducts online insurance eligibility/benefit verification, obtains pre-certification/authorization, referral clearance, and provides financial education on designated cases. As appropriate, the specialist notifies patients/guarantors, specialists, and referring providers with pertinent information, including clinical documentation and referral status.

Requirements

• High school diploma or equivalent required.
• Registered or Certified Medical Office Assistant OR 2 years of direct referral experience in lieu of certification required.
• 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 appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System.
• May be required to periodically rotate shifts and regular days off.
• Flexibility to meet the department hours of operation.
• Ability to communicate orally, see, and hear to collect information.
• Dexterity to operate office equipment.
• Subject to eyestrain due to hours spent looking at monitor screen.
• Noise level is low to moderate.
• Answers telephone calls.
• Uses computer and other business machines extensively.
• Bends, reaches, pushes and pulls file drawers to file records and reports.
• Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.

Nice To Haves

• Licensed Practical Nurse background preferred.
• 2 years insurance/referral experience within a hospital or medical office setting preferred.

Responsibilities

• Maintains a working knowledge of processes for medical administrative personnel, including comprehension of procedures for internal and external referrals and obtaining/sending protected patient information.
• Performs insurance eligibility/benefit verification using various mechanisms and ensures authorization matches the test(s)/specialty from referral receipt.
• Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance for service, procedure, or referral.
• Obtains specialist contact information; prints orders, patient demographics, and provider letters; documents appropriately in the electronic health record (EHR).
• Determines proper referral requirements and/or limitations according to the requested service, test, or procedure, including proper identification of emergent referrals.
• Pre-registers the patient for upcoming visit(s).
• Informs patient/guarantor of their liabilities, including referral approval or denial, and documents appropriately.
• Sends and/or communicates appointment confirmation to the referring office, and calls the patient to remind them of the appointment date, time, location, and preparation for procedures following protocols.
• Completes appropriate follow-up protocol as determined by leadership, related to the number of business days associated with routine and urgent referrals, from initiation to completion.
• Assists insurance companies, physicians, physician practices, and/or hospital departments with patient information in accordance with HIPAA guidelines.
• Meets or exceeds the accuracy standard goal determined by Patient Access Leadership.
• Other duties as assigned.

Benefits

• Exceptional healthcare
• Caring employees are committed to integrity, patient-centeredness and excellence throughout the entire healthcare process.
• Goal is to improve the quality of every life we touch.
• Diverse team of doctors, nurses and staff work together to create a better experience for every patient, every time.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED