Referral Specialist

About Wvumedicine

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Job Summary

Collects comprehensive detailed patient medical information, determining the need for nursing intervention and expediting care for those deemed urgent, interpreting and applying policies and procedures, providing financial education to customers regarding benefits to assist in their understanding of personal financial liability, and obtaining insurance verification and pre-certification.

Key Responsibilities

• Coordinates single case agreements and third party payer contracts, schedules appointments, tests and intervenes across multiple departments, clinics, and private medical offices.
• Coordinates medical information, records and films for upcoming appointments.
• Communicates patient status with internal and external providers.
• Answers patient phone calls and addresses concerns and needs.

Requirements

• High School or Equivalent
• Two years of clinical or customer service experience

Preferred Qualifications

• Three years of experience with direct customer service

Core Duties and 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. Assists 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.