Job Description

Clinical Referral Specialist, Centralized Referrals

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Medical Group Overview:

Covenant Medical Group is the employed and managed medical practice organization of Covenant Health, providing comprehensive care across East Tennessee. With more than 300 physicians and advanced practice providers in 20 communities, our team delivers expertise across a broad spectrum of specialties from primary care and walk-in clinics to preventive medicine and advanced surgical and subspecialty services. We are committed to offering coordinated, patient-centered care that spans the continuum of health needs, ensuring access to exceptional providers close to home.

The Referral and Precertification Specialists manages scheduling for specialty facilities and procedures, creates and registers new patient charts, verifies addresses, and submits insurance eligibility. They prioritize orders, obtain pre-certifications and follow up on referrals and authorizations to ensure timely patient care. The specialist collaborates with patients, providers, and nursing staff to ensure a team-based approach to patient care.

apply@covhlth.com

Responsibilities

• Schedules inpatient/outpatient tests, procedures and appointments as ordered by provider. Documents each scheduled event, all communications in detail in the medical records, Referral Management, Message Center, and the various pools.
• Coordinates date, time, and location of procedure/appointment with the patient, facility and provider.
• Communicates appointments as well as special instructions regarding scheduled procedure/appointment with the patient through various solutions (phone, patient portal and MedChat).
• Accurately assembles appropriate medical records to be faxed to external specialists or attached via referral order in the referral management system.
• Accurately completes all forms and pre-certifications required for referrals and diagnostics.
• Knowledge of requirements and guidelines as mandated by insurance plans, hospitals, and outpatient facilities.
• Professionally consult with providers and nursing staff regarding referrals, authorizations, and patient care plans.
• Communicate other options given by insurance carriers regarding prior authorizations
• Follows all departmental training manuals and workflow documents
• Keep logs of specialists, facilities, hospitals, and diagnostic centers current, including service locations, first available scheduling, accepted insurance payors, and contact information.
• Maintains accurate testing, referral, and appointment logs with follow-up verification in Referral Management and electronic medical record.
• Collaborate with the patient, physician, and other care team members as part of a team-based approach to overall patient care.
• Knowledge of ICD-10 and CPT coding, Microsoft Office, and Teams.
• Reports any problems obtaining referrals, pre-certifications or appointments as ordered by the provider.
• Attends meetings as required and participates on committees as directed.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education:

None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a Bachelor’s degree in a directly related field from an accredited college or university.

Minimum Experience:

One (1) to two (2) years’ experience in Referrals and Diagnostics with pre-certification experience. Medical terminology knowledge a must. At least 1 year of medical office experience and have knowledge of medical terminology is strongly preferred. Experience in referral and precertification strongly preferred.

Licensure Requirement:

None