Referral Specialist-Full Time-Days

Facility Referral Coordinator

Clinic Centralized Referrals

Location : Raeford, North Carolina

Department : Clinic Centralized Referrals

Job Family : Clerical

Work Shift : Days (United States of America)

Summary : 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.

Major Job Functions :

• Maintains a working knowledge of the processes for medical administrative personnel, inclusive of comprehension of procedures for internal and external referrals; obtaining and sending protected patient information
• Performs insurance eligibility / benefit verification, utilizing a variety of mechanisms and ensure authorization matches 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 demographic, and provider letter; documents as appropriate in electronic health record (EHR)
• Determines proper referral requirements and / or limitations according to requested service, test, or procedure, to include proper identification of emergent referrals
• Pre-registers the patient for upcoming visit(s)
• Informs patient / guarantor of their liabilities, to include referral approval or denial, and documents appropriately
• Sends and / or communicates appointment confirmation to referring office, as well as calls the patient to remind of appointment date, time, location, and preparation for procedures following protocols
• Completes appropriate follow-up protocol as determined by leadership, as it relates to number of business days associated with routine and urgent referrals; initiation to completion
• Assists insurance companies, physician and physician practices, and or hospital departments with patient information in accordance with HIPAA guidelines
• Meets or exceeds accuracy standard goal determined by Patient Access Leadership
• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job :

Education and Formal Training :

Work Experience :

Knowledge, Skills, and Abilities Required :

Physical Requirements :

Cape Fear Valley Health System is an Equal Opportunity Employer M / F / Disability / Veteran / Sexual Orientation / Gender Identity