Referral Specialist

WVU Medicine

About The Position

Collects comprehensive detailed patient medical information, determining the need for nursing intervention and expediting care for those deemed urgent, interpreting and applying polices and procedures, providing financial education to customers regarding benefits to assist in their understanding of personal financial liability, and obtaining insurance verification and pre-certification. Coordinates single case agreements and third party payer contracts, schedules appointments, tests and intervenes across multiple departments, clinics, and private medical offices. Coordinates medical information, records and films for upcoming appointments. Communicates patient status with internal and external providers. Answers patient phone calls and addresses concerns and needs.

Requirements

High School or Equivalent
Two years of clinical or customer service experience
Communicates effectively verbally and in writing and places high emphasis on customer service with referring physicians/offices and patients.
Demonstrates flexibility to meet the needs of department or hospital in regard to changes in work volume, planned change, scheduling changes and emergency call-backs (i.e. weather or disaster)
Working knowledge of computers
Excellent customer service and telephone etiquette
Must demonstrate the ability to use tact and diplomacy in dealing with others

Nice To Haves

Three years of experience with direct customer service
Basic knowledge of medical terminology preferred
Basic knowledge of third party payers preferred

Responsibilities

Captures complete and accurate patient information for medical triage of all spine referrals demonstrating understanding and skill in use of the Cordata software and of practice and physician protocols
Effectively identifies and processes urgent patients
Identifies patients requiring pre-certification or pre-authorization at the time outpatient services are requested
Obtains external medical records and transfers them to HIM and Cordata for medical review
Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing
Contacts pre-certification/insurance company to determine eligibility and benefits for requested services, as applicable
Advises the patient, referring physician, insurance company or provider of insurance coverage issues and customer financial responsibility
Obtains Workers Compensation authorization through the physician of record. Assists in completion of appropriate paperwork and documents authorization/certification numbers in the registration/billing systems and Cordata
Refers WVU Cares /self-pay patients to the financial counselor to determine eligibility, and to resolve questions regarding payment for treatment
Utilizing Epic, schedules clinic appointments with appropriate department as recommended
Communicates appointment date/time, directions and pre-procedure instructions with patient
Flags patient accounts for special notifications and informs clinic of necessary assistive devices for appointment
Explains insurance and payment requirements to patient
Receives, responds and attempts to resolve patient and referring physician/office needs and complaints appropriately and in a timely manner
Accurately moves patients through all stages of medical triage in Cordata system to ensure appropriate and timely care
Communicates patient needs and flow through the medical triage process via letter or Epic messages
Accurately records referring physician/office information in Cordata and submits updates/corrections to the Referring Physician Database via Ruby-on-Line as appropriate
Identifies duplicate Epic files and addresses issue with HIM
Participates in performance improvement (i.e. follows established work systems, identifies deviations or deficiencies in standards/systems/processes and communicates problems to manager or director)
Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth
Attends departmental meetings and/or documents review of meeting minutes