Referral Specialist- HYBRID

About the role

Collects comprehensive detailed patient medical information, determines the need for nursing intervention and expediting care for those deemed urgent, interprets and applies policies and procedures, provides financial education to customers regarding benefits to assist in their understanding of personal financial liability, and obtains insurance verification and pre-certification.

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
• Contacts 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.
• Affords assistance in completing 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

• Minimum Qualifications: 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

Physical Requirements

• Frequent walking, sitting, stooping, reaching, pushing, pulling, lifting, grasping and feeling are necessary body movements utilized in performing duties throughout the work shift
• Must be able to sit for extended periods of time
• Must have reading and comprehension ability
• Visual acuity must be within normal range
• Must be able to communicate effectively
• Must be able to exert in excess of 50 pounds of force occasionally to move objects
• Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment

Working Environment

• Office type environment