Referral Specialist-Full Time-Days

Valley Orthopedics & Sports Medicine Fayetteville, North Carolina Valley Orthopedics & Sports Medicine Clerical Days (United States of America) Obtains and/or verifies demographic, clinical, financial, and insurance information. Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Obtains and processes signed physician orders/referrals to ensure accurate clinical documentation for care delivery, specialty and outpatient ancillary referrals. In addition, the referral coordinator will conduct online insurance eligibility/benefit verification, obtain pre-certification/authorization, referral clearance and financial education on designated cases. As appropriate; notifies patient/guarantor, specialist, referring provider, etc., with pertinent information, inclusive of, but not limited to clinical documentation, referral status, follow-up, etc.Two to four years (2-4) insurance/referral experience within a hospital or medical office setting preferred. LPN back ground a plus. Medical Terminology required. Must pass pre-employment testing and post-training testing. Must pass and maintain the Certified Healthcare Access Associate (CHAA) exam within one year of employment. Must have knowledge of insurance and collection of payments. Must have experience with Microsoft software. Must possess excellent verbal and written communication skills, customer service skills and problem solving abilities. Must be multi-skilled with the ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System. May be required to periodically rotate shifts and regular days off. All system employees must have the flexibility to meet the department hours of operation.Must be able to communicate orally, see, and hear to collect information. Must have dexterity to operate office equipment. Position operates in an office, call center environment. Work area is well-lit, temperature controlled and free from hazards. The incumbent is subject to eyestrain due to the many hours spent looking at a CRT screen. The noise level is low to moderate. Answers telephone calls, uses personal computer and other business machines extensively. Bends, reaches, pushes and pulls file drawers to file records and reports. Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds.