Advertised Referral & Pre-Certification Specialist, Centralized Referrals

Overview

Referral & Pre-certification Specialist, Centralized Referrals

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Medical Group is Covenant Health's employed and managed medical practice organization, with more than 300 top Physicians and providers spanning the continuum of care in 20 cities throughout East Tennessee. Specialties include cardiology, cardiothoracic surgery, cardiovascular surgery, endocrinology, gastroenterology, general surgery, infectious disease, neurology, neurosurgery, obstetrics and gynecology, occupational medicine, orthopedic surgery, physical medicine and rehabilitation, primary care, pulmonology, reproductive medicine, rheumatology, sleep medicine and urology.

Position Summary :

Directs daily operation of scheduling for inpatient / outpatient procedures and services. Obtains any necessary referrals or pre-certifications.

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.

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.

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.

Perform other duties as assigned or requested.

Attends meetings as required and participates on committees as directed.

Collaborate with the patient, physician and other care team members as part of a team based approach to overall patient care.

Qualifications

Minimum Education :

None specified; will accept any combination of formal education and / or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a HS diploma or GED.

Minimum Experience :

Previous referral / pre-certification experience preferred. Medical terminology knowledge a must. At least 1 year of medical office experience and have knowledge of medical terminology is strongly preferred. Experience in referral and precertification strongly preferred.

Licensure Requirement :

None