Referral Specialist - IPN Admin

Description

The Referral Specialist will be responsible for managing the procurement of pre-authorizations, estimations, and/or referrals by practices and other facilities, for potential services that are scheduled at an Iredell Health location. Including verifying, retrieving, and updating the patient’s major medical health plan benefits; and documenting this information in the hospital’s health care technology system.  

• Verify that all required pre-authorizations, estimations, and/or referrals have been completed by practices and other facilities and that they have been assigned to the correct department.
• Responsible for prioritizing Stat pre-authorizations, estimations, and/or referrals.
• Follow up on sent pre-authorizations, estimations, and/or referrals.
• Review patient benefits and eligibility to communicate with clinician and clinical staff pertaining to pre-authorizations, estimations, and/or referrals.
• Keep the system up to date with any changes in information.
• Manage pre-authorization, estimation, and/or referral status to ensure Iredell Health location(s) have all updated and current information.
• Obtains and maintain pre-authorizations, estimations, and/or referrals for diagnostic and ancillary testing.
• Handle sensitive information in a confidential manner.
• Verifies insurance coverage and patient demographics, when necessary.
• Communicates as needed with health care professionals and clinic staff to clarify diagnoses or obtain additional information.
• Updates registration documentation to ensure that information is complete and filed appropriately.
• All other duties as assigned.

Requirements

High School graduate or GED.

Minimum 2 years’ experience in a health coordination role, preferred

Demonstrated understanding of industry guidelines and best practices.

Thorough understanding of insurance coverage and Medical Necessity policies, desired.

Customer service experience required.

Strong attention to detail, analytical skills, and ability to work independently.

Ability to operate a computer, basic office equipment and multi-line telephone system.

Must be well organized, detail oriented, and obtain excellent communication skills.