Referral Care Coordinator: Access & Care Coordination

Veterans in Healthcare; Spartanburg (SC); On-site; USD 40,000 - 60,000; Full time

Job summary

Spartanburg Regional Healthcare System in Greer, SC seeks a Referral Specialist to coordinate patient referrals at the request of providers and ensure insurance coverage aligns with services ordered. The role includes coordinating pre-certification, communicating with payers, and assisting with financial screening to ease patient burdens.

Excellent written and oral communication skills are essential, and the specialist will document all stages in the EMR, support clinical staff, and maintain

Qualifications

• High School Diploma or equivalent with some college or associates degree.
• Minimum of five years of healthcare related experience with one of a combination of the following: patient finance, insurance benefits, financial assistance programs, public health, social services, administrative support or other health related experience.
• Typing 50 words per minute minimum, HCPCS, ICD10 and/or CPT coding, knowledge of insurance, financial experience. Previous experience in Hospital/Physician's office setting with in-depth knowledge and experience.

Responsibilities

• Performs patient referrals timely by completing and submitting documents and discussing with providers, insurance carriers and patients.
• Ensures patients have cleared medical necessity and authorization for specialty services (infusion/injection, diagnostic tests, referrals to other offices/facilities and specialties). This applies to scheduled and emergent patients.
• Serves as an expert in insurance verification, eligibility and medical necessity
• This person serves as a liaison between hospitals, physicians, clinical team, patients, pharmacies, vendors, referral sources, and contracted insurance plans.
• The Specialist will be instrumental in obtaining written documentation, tracking, and reporting outcomes of each authorization request.
• Resolves pre-certification case related concerns prior to patient's appointment
• Maintain referral records documenting communication, actions, and other data in the information system
• Provides support to clinical staff in order to facilitate the administrative components of the referral
• Schedule, confirm, and communicate patient appointments as applicable
• Performs service estimates and communicates to patients.
• Performs financial screening for assistance with patients communicating indigent assistance, charity care, and copay/coinsurance assistance options and enrollment
• May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary services for the patient in a timely fashion.
• Enters or checks patient registration demographics and makes corrections as needed.
• Responds to incoming calls regarding status from patients and insurance companies.
• Works to identify insurance trends and potential financial barriers to care and reports such issues to program administrator.
• Establishes rapport with patients by facilitating open conversation during the referral process. Consistently keeps patients abreast of any additional information related to the referral process.
• Provides education and information to co-workers and other staff as it relates to referrals.
• Assists provider in identifying appropriate network/healthcare provider to use for referrals as necessary. Referrals are made to authorized providers as specified by the insurer and/or patient requests.
• Prioritizes work to ensure that urgent referrals are handled expeditiously and routines are handled on a first come, first serve basis.
• Ensures that proper documentation is forwarded as needed and copies of documentation are retained in the patient's medical record. Serves as a resource to patients, providers and staff to facilitate the referral process in a timely and accurate manner.
• Counsels patients on financial liability using available financial counseling tools to achieve maximum reimbursement for patient services.
• Problem Solving: Identifies, analyzes, and effectively solves problems.
• This job requires the application and interpretation of policies and procedures and the use of independent judgment in a medical setting. The individual must possess the ability to maintain a working knowledge of carrier information/changes and departmental policies and procedures.
• Must be able to operate independently to complete all tasks with minimal supervision.
• Must have good interpersonal skills to interact with individuals in all levels of the hospital and the public.
• Must have good organizational skills and be able to manage multiple tasks at the same time.
• Must be accountable for accuracy and timeliness of work.
• Must be trustworthy and committed to confidentiality.
• Incumbent has access to confidential hospital, patient, and financial information.

Education

High School Diploma or equivalent with some college or associates degree

Job description

Spartanburg Regional Healthcare System in Greer, SC seeks a Referral Specialist to coordinate patient referrals at the request of providers and ensure insurance coverage aligns with services ordered. The role includes coordinating pre-certification, communicating with payers, and assisting with financial screening to ease patient burdens.

Excellent written and oral communication skills are essential, and the specialist will document all stages in the EMR, support clinical staff, and maintain