Referral Specialist

Referral Specialist page is loaded## Referral Specialist locations:
Saint Francis Hospital (SFH) time type:
Full time posted on:
Posted Todayjob requisition :
JR25-12251## Welcome! We’re excited you’re considering an opportunity with us!

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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.
** MINIMUM QUALIFICATIONS****:
**** EDUCATION, CERTIFICATION, AND/OR LICENSURE:
** 1. High School or Equivalent
*
* EXPERIENCE:

** 1. Two years of clinical or customer service experience
** PREFERRED QUALIFICATIONS****:
***
* EXPERIENCE:

** 1. Three years of experience with direct customer service
** CORE

DUTIES AND RESPONSIBILITIES:

** The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned
1. 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
2. Effectively identifies and processes urgent patients
3. Identifies patients requiring pre-certification or pre-authorization at the time outpatient services are requested
4. Obtains external medical records and transfers them to HIM and Cordata for medical review
5. Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing
6. Contacts pre-certification/insurance company to determine eligibility and benefits for requested services, as applicable
7. Advises the patient, referring physician, insurance company or provider of insurance coverage issues and customer financial responsibility
8. 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
9. Refers WVU Cares /self-pay patients to the financial counselor to determine eligibility, and to resolve questions regarding payment for treatment
10. Utilizing Epic, schedules clinic appointments with appropriate department as recommended
11. Communicates appointment date/time, directions and pre-procedure instructions with patient
12. Flags patient accounts for special notifications and informs clinic of necessary assistive devices for appointment
13. Explains insurance and payment requirements to patient
14. Receives, responds and attempts to resolve patient and referring physician/office needs and complaints appropriately and in a timely manner
15. Accurately moves patients through all stages of medical triage in Cordata system to ensure appropriate and timely care
16. Communicates patient needs and flow through the medical triage process via letter or Epic messages
17. Accurately records referring physician/office information in Cordata and submits updates/corrections to the Referring Physician Database via Ruby-on-Line as appropriate
18. Identifies duplicate Epic files and addresses issue with HIM
19. Participates in performance improvement (i.e. follows established work systems, identifies deviations or deficiencies in…