Referral Specialist

About the role

ABC Home Medical Supply, Inc is one of the nation’s leading urological supply providers and serves as a one-stop shop with a comprehensive line of medical supplies and service that includes: Urological, Incontinence, Wound Care, and Ostomy. ABC Medical is part of the JDS, Inc family of businesses. Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services. Location: Nashville.

Responsibilities

• The Referral Specialist is responsible for verifying, obtaining, reviewing, and accurately determining that all medical documentation received from physicians or referral sources meets all local coverage determinations and regulatory requirements.
• The Referral Specialist is responsible for the Pre-authorization functionality.
• Examine documents to verify required compliance, completeness, and accuracy of data.
• Confer with document originator and approvers to resolve identified discrepancies.
• Contact insurance companies to confirm insurance coverage and eligibility of products.
• Obtain prior authorization and/or referrals.
• Appropriately update customer database when obtaining documents and pre-authorizations.
• Appropriately update document databases, and corresponding files.
• Generate communication to the appropriate personnel on new and revised documents including Pre-authorization requests.
• Regularly communicate with Health Care Providers, Commercial and Government Payors, and Sales Managers.
• Achieve defined service level agreements.
• Communicate Payor requirements as they are discovered.
• Adheres to all HIPAA guidelines/regulations.

Qualifications

• High School Diploma or equivalent work experience
• 2+ years of work experience
• Basic understanding of payor guidelines
• Analytical skills required, attention to detail, and organized
• Basic Microsoft skills
• Ability to work well in a team environment
• Previous DME experience (preferred)

Benefits

• Variety of Medical, Dental and Vision Insurance Plans
• 401k Plan with Company Match
• PTO and Paid Holidays
• EAP
• Employee Discounts

Schedule

Monday-Friday; Hours: 8:30am-5pm local time