Referral Specialist-Full Time-Days

Cape Fear Valley Health

5d • Onsite

About The Position

Obtains and/or verifies demographic, clinical, financial, and insurance information. Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Obtains and processes signed physician orders/referrals to ensure accurate clinical documentation for care delivery, specialty and outpatient ancillary referrals. In addition, the referral coordinator will conduct online insurance eligibility/benefit verification, obtain pre-certification/authorization, referral clearance and financial education on designated cases. As appropriate; notifies patient/guarantor, specialist, referring provider, etc., with pertinent information, inclusive of, but not limited to clinical documentation, referral status, follow-up, etc.Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity For exceptional healthcare come to Cape Fear Valley Health where caring employees are committed to integrity, patient-centeredness and excellence throughout the entire healthcare process. At Cape Fear Valley Health, our goal is to improve the quality of every life we touch. Our diverse team of doctors, nurses and staff work together to create a better experience for every patient, every time. Cape Fear Valley is a 950-bed, 8-hospital regional health system, the 8th largest in North Carolina, with more than 1 million inpatient and outpatients annually. A private not-for-profit organization with over 7,000 employees and 850 physicians. Our employees and physicians proudly serve a seven-county region of southeastern North Carolina, including Fayetteville, Fort Bragg, Hope Mills, Raeford, Lumberton, Elizabethtown, Clinton, Lillington, Dunn and beyond. Our medical facilities include Cape Fear Valley Medical Center, Highsmith-Rainey Specialty Hospital, Cape Fear Valley Rehabilitation Center, Behavioral Health Care, Bladen County Hospital, Hoke Hospital, Central Harnett Hospital, Betsy Johnson Hospital, as well as more than 60 medical offices and specialty care clinics spread throughout the Cape Fear region.

Requirements

• Medical Terminology required.
• Must pass pre-employment testing and post-training testing.
• Must pass and maintain the Certified Healthcare Access Associate (CHAA) exam within one year of employment.
• Must have knowledge of insurance and collection of payments.
• Must have experience with Microsoft software.
• Must possess excellent verbal and written communication skills, customer service skills and problem solving abilities.
• Must be multi-skilled with the 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.
• All system employees must have the flexibility to meet the department hours of operation.
• Must be able to communicate orally, see, and hear to collect information.
• Must have dexterity to operate office equipment.
• 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

• Two to four years (2-4) insurance/referral experience within a hospital or medical office setting preferred.
• LPN back ground a plus.

Responsibilities

• Obtains and/or verifies demographic, clinical, financial, and insurance information.
• Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.
• Obtains and processes signed physician orders/referrals to ensure accurate clinical documentation for care delivery, specialty and outpatient ancillary referrals.
• Conduct online insurance eligibility/benefit verification, obtain pre-certification/authorization, referral clearance and financial education on designated cases.
• Notifies patient/guarantor, specialist, referring provider, etc., with pertinent information, inclusive of, but not limited to clinical documentation, referral status, follow-up, etc.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed