Referral Specialist-Full Time-Days at Cape Fear Valley Health

, , United States -

Full Time

Start Date

Immediate

Expiry Date

02 Jan, 26

Salary

0.0

Posted On

05 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medical Terminology, Insurance Verification, Referral Coordination, Patient Communication, Documentation, Customer Service, Problem Solving, Microsoft Software, HIPAA Compliance, Pre-Certification, Financial Education, Clinical Documentation, Appointment Scheduling, Medical Necessity Validation, EHR Management, Complexity Handling

Industry

Hospitals and Health Care

Description

Facility CFV Fayetteville Orthopedics & Sports Medicine Location Fayetteville, North Carolina Department Cape Fear Valley Fayetteville Orthopedics & Sports Medicine Job Family Clerical Work Shift Days (United States of America) Summary Obtains and/or verifies demographic, clinical, financial, and insurance information. Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Obtains and processes signed physician orders/referrals to ensure accurate clinical documentation for care delivery, specialty and outpatient ancillary referrals. In addition, the referral coordinator will conduct online insurance eligibility/benefit verification, obtain pre-certification/authorization, referral clearance and financial education on designated cases. As appropriate; notifies patient/guarantor, specialist, referring provider, etc., with pertinent information, inclusive of, but not limited to clinical documentation, referral status, follow-up, etc. Major Job Functions The following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below. In addition, specific functions may change from time to time: Maintains a working knowledge of the processes for medical administrative personnel, inclusive of comprehension of procedures for internal and external referrals; obtaining and sending protected patient information Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms and ensure authorization matches test(s)/specialty from referral receipt Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance for service, procedure, or referral Obtains specialist contact information; prints orders, patient demographic, and provider letter; documents as appropriate in electronic health record (EHR) Determines proper referral requirements and/or limitations according to requested service, test, or procedure, to include proper identification of emergent referrals Pre-registers the patient for upcoming visit(s) Informs patient/guarantor of their liabilities, to include referral approval or denial, and documents appropriately Sends and/or communicates appointment confirmation to referring office, as well as calls the patient to remind of appointment date, time, location, and preparation for procedures following protocols Completes appropriate follow-up protocol as determined by leadership, as it relates to number of business days associated with routine and urgent referrals; initiation to completion Assists insurance companies, physician and physician practices, and or hospital departments with patient information in accordance with HIPAA guidelines Meets or exceeds accuracy standard goal determined by Patient Access Leadership Other duties as assigned Minimum Qualifications The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job: Education and Formal Training: Registered or Certified Medical Office Assistant or 2-4 years of direct referral experience in lieu of certification Licensed Practical Nurse background preferred Medical Terminology required Work Experience: 2-4 years insurance/referral experience within a hospital or medical office setting preferred Knowledge, Skills, and Abilities Required: Pass pre-employment testing and post-training testing Pass and maintain the Certified Healthcare Access Associate (CHAA) exam within one year of employment Knowledge of insurance and collection of payments Experience with Microsoft software Excellent verbal and written communication skills, customer service skills and problem solving abilities Ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System May be required to periodically rotate shifts and regular days off Flexibility to meet the department hours of operation Physical Requirements: Ability to communicate orally, see, and hear to collect information Dexterity to operate office equipment Subject to eyestrain due to hours spent looking at monitor screen Noise level is low to moderate Answers telephone calls Uses computer and other business machines extensively Bends, reaches, pushes and pulls file drawers to file records and reports Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds Required Licenses and Certifications Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity For exceptional healthcare come to Cape Fear Valley Health where caring employees are committed to integrity, patient-centeredness and excellence throughout the entire healthcare process. At Cape Fear Valley Health, our goal is to improve the quality of every life we touch. Our diverse team of doctors, nurses and staff work together to create a better experience for every patient, every time. Cape Fear Valley is a 950-bed, 8-hospital regional health system, the 8th largest in North Carolina, with more than 1 million inpatient and outpatients annually. A private not-for-profit organization with over 7,000 employees and 850 physicians. Our employees and physicians proudly serve a seven-county region of southeastern North Carolina, including Fayetteville, Fort Bragg, Hope Mills, Raeford, Lumberton, Elizabethtown, Clinton, Lillington, Dunn and beyond. Our medical facilities include Cape Fear Valley Medical Center, Highsmith-Rainey Specialty Hospital, Cape Fear Valley Rehabilitation Center, Behavioral Health Care, Bladen County Hospital, Hoke Hospital, Central Harnett Hospital, Betsy Johnson Hospital, as well as more than 60 medical offices and specialty care clinics spread throughout the Cape Fear region.

Responsibilities

The Referral Specialist is responsible for obtaining and verifying demographic, clinical, financial, and insurance information, as well as validating medical necessity for referrals. They also process physician orders and communicate pertinent information to patients and providers.