Clinical Referral Specialist, CMG Referrals

Clinical Referral Specialist

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Medical Group Overview:

Covenant Medical Group is the employed and managed medical practice organization of Covenant Health, providing comprehensive care across East Tennessee. With more than 300 physicians and advanced practice providers in 20 communities, our team delivers expertise across a broad spectrum of specialties from primary care and walk-in clinics to preventive medicine and advanced surgical and subspecialty services. We are committed to offering coordinated, patient-centered care that spans the continuum of health needs, ensuring access to exceptional providers close to home.

Position Summary:

The Referral and Precertification Specialists manages scheduling for specialty facilities and procedures, creates and registers new patient charts, verifies addresses, and submits insurance eligibility. They prioritize orders, obtain pre-certifications and follow up on referrals and authorizations to ensure timely patient care. The specialist collaborates with patients, providers, and nursing staff to ensure a team-based approach to patient care.

Responsibilities

• Schedule inpatient/outpatient tests, procedures, and appointments as directed by provider. Documents each event in detail in the medical record.
• Accurately completes all forms required for referrals and pre-certifications (authorizations).
• Authorizations are obtained from the patient's insurance and added to the electronic health record.
• Knowledge of requirements and guidelines as mandated by insurance plans, hospitals, outpatient facilities, and ambulatory practices.
• Maintains accurate testing, referral, and appointment logs with follow-up verification in the Referral/Diagnostic tracking database.
• Knowledge of ICD-10, CPT Coding, and basic computer skills.
• Coordinates date, time, and location of procedure/appointment with the patient, facility, and provider.
• Communicates appointments as well as special instructions regarding scheduled procedure/appointment with the patient.
• For Internal Referrals, the patient will be notified of an appointment by the provider's practice receiving the referral.
• For External Referrals, the office staff will verify whether the practice receiving the referral will contact the patient regarding appointment information. If they will not then CMG staff will communicate appointment information to the patient by phone, text, patient portal, and/or USPS mail.
• Report any problems obtaining referrals, pre-certifications or appointments as ordered by the provider.
• Collaborate with the patient, physician, and other care team members as part of a team-based approach to overall patient care.
• Assists in the orientation and education of Centralized Referral team.
• Assists in the development and maintenance of departmental training manuals and workflow documents.
• Provides support and assistance for employees.
• Professionally consults with patients, providers, and hospital staff members regarding the scheduling and pre-registration of appointments.
• Attends meetings as required and participates on committees as directed.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education: None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a Bachelor's degree in a directly related field from an accredited college or university.

Minimum Experience: One (1) to two (2) years' experience in Referrals and Diagnostics with pre-certification experience. Medical terminology knowledge a must.

Licensure Requirement: None