Referral Specialist processes insurance pre-verification for hospital admissions or specialty service office visits. Gathers pertinent information from patients, insurance carriers, financial counselors, and other staff to confirm the patient's financial obligations for services. Being a Referral Specialist acts as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals. Verifies insurance coverage and obtains required authorizations when necessary. Additionally, Referral Specialist documents referrals, communications, actions, and other data in an information management system. Generates and distributes all applicable forms, notifications, and paperwork. Requires a high school diploma. Typically reports to a supervisor. The Referral Specialist works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Referral Specialist typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
ABC Home Medical Supply, Inc is one of the nation’s leading urological supply providers and serves as a one-stop shop with a comprehensive line of medical supplies and service that includes : Urological, Incontinence, Wound Care, and Ostomy.
ABC Medical is part of the JDS, Inc family of businesses. Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services.
Location : Trevose
Department : Summary :
Summary :
The Referral Specialist is responsible for verifying, obtaining, reviewing, and accurately determining that all medical documentation received from physicians or referral sources meet all Local Coverage Determinnations and regulatory requirements.
The Referral Specialist is responsible for the Pre-authorization functionality.
Location :
In Office - Trevose, PA; Centenniel, CO; Port St. Lucie, FL
Responsibilites :
Include the following as well as other duties and responsibilities, which may be assigned.
Examine documents to verify required compliance, completeness, and accuracy of data.
Confer with document originator and approvers to resolve identified discrepancies.
Contact insurance companies to confirm insurance coverage and eligibility of products.
Obtain prior authorization and / or referrals.
Appropriately update document databases, and corresponding files.
Generate communication to the appropriate personal on new and revised documents including Pre-authorization request.
Regularly communicate with internal and external partners, including Customer Service, Referral Management, Sales, and Payors.
Achieve defined Service Leval Agreements.
Communicate Payor requirements as they are discovered.
Adheres to all HIPAA guidelines / regulations.
Follows company policies and procedures.
Qualifications :
High School Diploma or equivalent work experience.
Basic understanding of payor guidelines.
Analytical skills required, attention to detail, and organized.
2 years of work experience
Previous DME experience a plus.
Basic Microsoft skills.
Ability to work well in a team environment
Job Req ID : 32895
Last updated : 2024-04-23