Referral Specialist

Job Title

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. 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 outpatient services are requested

4. Obtains external medical records and transfers them to HIM and Cordata for medical review

5. Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing

6. Contacts pre-certification/insurance company to determine eligibility and benefits for requested services, as applicable

7. Advises the patient, referring physician, insurance company or provider of insurance coverage issues and customer financial responsibility

8. 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

9. Refers WVU Cares /self-pay patients to the financial counselor to determine eligibility, and to resolve questions regarding payment for treatment

10. Utilizing Epic, schedules clinic appointments with appropriate department as recommended

11. Communicates appointment date/time, directions and pre-procedure instructions with patient

12. Flags patient accounts for special notifications and informs clinic of necessary assistive devices for appointment

13. Explains insurance and payment requirements to patient

14. Receives, responds and attempts to resolve patient and referring physician/office needs and complaints appropriately and in a timely manner

15. Accurately moves patients through all stages of medical triage in Cordata system to ensure appropriate and timely care

16. Communicates patient needs and flow through the medical triage process via letter or Epic messages

17. Accurately records referring physician/office information in Cordata and submits updates/corrections to the Referring Physician Database via Ruby-on-Line as appropriate

18. Identifies duplicate Epic files and addresses issue with HIM

19. 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)

20. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth

21. Attends departmental meetings and/or documents review of meeting minutes

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Frequent walking, sitting, stooping, reaching, pushing, pulling, lifting, grasping and feeling are necessary body movements utilized in performing duties throughout the work shift

2. Must be able to sit for extended periods of time

3. Must have reading and comprehension ability

4. Visual acuity must be within normal range

5. Must be able to communicate effectively

6. Must be able to exert in excess of 50 pounds of force occasionally to move objects

7. Must have manual dexterity to operate keyboards, fax machines, telephones and other business equipment

Working Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Office type environment

Skills and Abilities

1. Communicates effectively verbally and in writing and places high emphasis on customer service with referring physicians/offices and patients.

2. 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)

3. Working knowledge of computers

4. Basic knowledge of medical terminology preferred

5. Basic knowledge of third party payers preferred

6. Excellent customer service and telephone etiquette

7. Must demonstrate the ability to use tact and diplomacy in dealing with others

Additional Job Description

Scheduled Weekly Hours: 40

Shift:

Exempt/Non-Exempt: United States of America (Non-Exempt)

Company: THOM Thomas Hospitals

Cost Center: 550 THSP Scheduling Call Center

Address: 333 Laidley Street Charleston West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.