Referral Specialist

About the role

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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
• Contact 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
• Aids 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
• 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

Qualifications

• EDUCATION, CERTIFICATION, AND/OR LICENSURE: High School or Equivalent
• EXPERIENCE: Two years of clinical or customer service experience
• PREFERRED QUALIFICATIONS: Three years of experience with direct customer service

Skills and Abilities

• 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
• Basic knowledge of medical terminology preferred
• Basic knowledge of third party payers preferred
• Excellent customer service and telephone etiquette
• Must demonstrate the ability to use tact and diplomacy in dealing with others