Referral Specialist

ABC Medical; Mount Juliet (TN); On-site; USD 23,000 - 32,000; Full time

Benefits offered by this job

Medical, Dental and Vision Insurance

401k Plan with Company Match

PTO and Paid Holidays

EAP

Employee Discounts

Job summary

ABC Home Medical Supply, Inc, located in Nashville, TN, is seeking a Referral Specialist to verify and process medical documentation for pre-authorizations and referrals. The role supports compliance with local coverage determinations and regulatory requirements, coordinating with physicians, insurers, and care teams.

The position emphasizes accuracy, timely communication with payors, and updating patient and document records while upholding HIPAA guidelines. Monday-Friday, 8:30am-5pm local time.

Qualifications

• High School Diploma or equivalent required.
• 2+ years of work experience preferred.
• Basic understanding of payor guidelines.
• Analytical and detail-oriented.
• Proficiency with Microsoft Office products.
• Ability to work well in a team environment.

Responsibilities

• Verify, obtain, review, and determine that medical documentation meets local coverage determinations and regulatory requirements.
• Pre-authorization functionality management.
• Examine documents for completeness and accuracy.
• Resolve discrepancies with document originators and approvers.
• Contact insurance companies to confirm coverage and eligibility of products.
• Obtain prior authorization and/or referrals.
• Update customer databases and filing systems accordingly.
• Generate communications for new and revised documents including pre-authorization requests.
• Maintain HIPAA compliance.

Skills

Analytical skills

Attention to detail

Organized

Microsoft Office

Team player

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

ABC Home Medical Supply, Inc is oneof the nation's leading urological supply providers andserves as a one-stopshop 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:

Nashville

Work Location:

Monday-Friday; Hours: 8:30am-5pm local time

Responsibilities:

The Referral Specialist is responsible for verifying, obtaining, reviewing, and accurately determining that all medical documentation received from physicians or referral sources meets all local coverage determinations and regulatory requirements. The Referral Specialist is responsible for the Pre-authorization functionality.

• 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 customer database when obtaining documents and pre-authorizations.
• Appropriately update document databases, and corresponding files.
• Generate communication to the appropriate personnel on new and revised documents including Pre-authorization requests.
• Regularly communicate with Health Care Providers, Commercial and Government Payors, and Sales Managers.
• Achieve defined service level agreements.
• Communicate Payor requirements as they are discovered.
• Adheres to all HIPAA guidelines/regulations.

Minimum Qualifications:

• High School Diploma or equivalent work experience
• 2+ years of work experience
• Basic understanding of payor guidelines
• Analytical skills required, attention to detail, and organized
• Basic Microsoft skills.
• Ability to work well in a team environment

Preferred Qualifications:

• Previous DME experience

Here’s what we have to offer:

• Variety of Medical, Dental and Vision Insurance Plans
• 401k Plan with Company Match
• PTO and Paid Holidays
• EAP
• Employee Discounts

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Team members shall adhere to high standards of ethical conduct and will comply with and assist the Company in complying with all policies and applicable laws and regulations.

Accommodations Statement:

ABC Medical endeavors to make www.abc-med.com accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the ABC Medical HR Department at [e-mail]. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.