Referral Specialist - IPN Admin

About the role

The Referral Specialist will manage the procurement of pre-authorizations, estimations, and/or referrals by practices and other facilities for potential services scheduled at an Iredell Health location.

Responsibilities

• Verify, retrieve, and update the patient’s major medical health plan benefits and document this information in the hospital’s health care technology system.
• Prioritize Stat pre-authorizations, estimations, and/or referrals.
• Follow up on sent pre-authorizations, estimations, and/or referrals.
• Review patient benefits and eligibility to communicate with clinicians and clinical staff regarding pre-authorizations, estimations, and/or referrals.
• Keep the system up to date with any changes in information.
• Manage pre-authorization, estimation, and/or referral status to ensure Iredell Health locations have all updated and current information.
• Obtain and maintain pre-authorizations, estimations, and/or referrals for diagnostic and ancillary testing.
• Handle sensitive information in a confidential manner.
• Verify insurance coverage and patient demographics, when necessary.
• Communicate as needed with healthcare professionals and clinic staff to clarify diagnoses or obtain additional information.
• Update registration documentation to ensure that information is complete and filed appropriately.

Requirements

• A high school diploma or equivalent.
• Minimum 2 years’ experience in a health coordination role, preferred.
• Demonstrated understanding of industry guidelines and best practices.
• Thorough understanding of insurance coverage and Medical Necessity policies, desired.
• Customer Service Experience Required.
• Strong attention to detail, analytical skills, and ability to work independently.
• Ability to operate a computer, basic office equipment, and multi-line telephone system.
• Must be well organized, detail oriented, and possess excellent communication skills.

Benefits

(No specific benefits mentioned)

Pay

(No specific pay information mentioned)

Schedule

(No specific schedule information mentioned)