WVUH West Virginia University Hospitals
ReferralSpecialist
Neural analysis suggests this role is
optimal for Entry candidates.
“Referral Specialist at WVUH West Virginia University Hospitals. Skills: Patient medical information collection, Nursing intervention determination, Financial education, Insurance verification and pre-certification, Single case agreement coordination, Third party payer contract coordination, Appointment scheduling, Medical record coordination, Patient communication, Urgent patient identification and processing, Pre-authorization, Eligibility and benefits determination, Insurance coverage issue ad”
Industry & Context.
Receives, responds and attempts to resolve patient and referring physician/office needs and complaints appropriately and in a timely manner
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 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, 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)
What They're Looking For.
Must Have
High School or Equivalent, Two years of clinical or customer service experience
Nice to Have
Three years of experience with direct customer service, Basic knowledge of medical terminology, Basic knowledge of third party payers
What You'll Do.
Collects comprehensive detailed patient medical information
determining the need for nursing intervention and expediting care for those deemed urgent
Interprets and applies polices and procedures
Provides financial education to customers regarding benefits to assist in their understanding of personal financial liability
Obtains insurance verification and pre-certification
Coordinates single case agreements and third party payer contracts
Schedules appointments
tests and intervenes across multiple departments
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
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/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
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
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
responds and attempts to resolve patient and referring physician/office needs and complaints appropriately and in a timely manner
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
How You'll Work.
Team & Collaboration
Communicates patient status with internal and external providers; Communicates patient needs and flow through the medical triage process via letter or Epic messages; Informs clinic of necessary assistive devices for appointment; Addresses issue with HIM
Communication Scope
Communicates effectively verbally and in writing; Excellent customer service and telephone etiquette; Must be able to communicate effectively
Full Job Description
## Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Collects comprehensive detailed patient medical information, determining the need for nursing intervention and expediting care for those deemed urgent, interpreting and applying polices 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. 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. **_MINIMUM QUALIFICATIONS_****:** **EDUCATION, CERTIFICATION, AND/OR LICENSURE:** 1\. High School or Equivalent **EXPERIENCE:** 1\. Two years of clinical or customer service experience ** _PREFERRED QUALIFICATIONS_****:** **EXPERIENCE:** 1\. Three years of experience with direct customer service **CORE DUTIES AND RESPONSIBILITIES:** The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned 1\. 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 2\. Effectively identifies and processes urgent patients 3\. Identifies patients requiring pre-certification or pre-authorization at the time outpat
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