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REFERRAL SPECIALIST - (20584)

Universal Health Services


Location:
EDINBURG, TX
Date:
02/22/2018
2018-02-222018-03-23
Job Code:
20584
Universal Health Services
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Job Details

Deltek Talent Management - REFERRAL SPECIALIST - (20584)

Job Details


REFERRAL SPECIALIST - (20584)

Facility Name
Business Office
Location
EDINBURG, TX 78539 US (Primary)
Career Area
Allied Health
Category
Other
Job Description

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POSITION SUMMARY:

Responsible for the scheduling referrals for patients of VCC/HC providers; Pre-authorizing and pre-certifying tests/procedures for VCC/HC providers.  Scheduling of other tests with facilities at the request of VCC/HC providers and/or staff.  Directly communicates with VCC/HC clinics, referred to clinics, and patients. Reviews clinical data to report medical necessity to insurance companies. Performs all work with accord to the mission, vision and values of VCC/HC.  Reports to Practice Administrator/Manager.

 

JOB SPECIFIC DUTIES

Referral Specialist is responsible for the scheduling referrals for patients of VCC/HC providers.
Accountable for the pre-authorizations and pre-certifications of all tests/procedures from VCC/HC providers for patients.
Responsible for the scheduling of other tests with facilities at the request of VCC/HC providers and/or staff.
Must be able to directly communicate with VCC/HC clinics, referred to clinics, and patients.
Expected to review clinical data to report medical necessity to appropriate insurance companies.
Fulfills clerical responsibilities as assigned
Travels between facilities as requested
Other duties as assigned by management

Job Requirements

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QUALIFICATIONS:

Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, federal and state insurance regulations and HIPAA privacy standards is strongly preferred.

Typing, 10 key and computer skills required.

Proficiency in Microsoft Office applications required.

Required effective interpersonal skills and excellent written, oral communication skills required.

Acute healthcare knowledge and ability to evaluate clinical data to acquire pre-authorizations and referrals is preferred.

Knowledge of third party reimbursement regulations is preferred.

Patient Management, Billing and Managed Care system processes competency.

Understanding of functions and work flow of Clinical/Hospital departments.

Excellent planning and organizational skills.

Demonstration of strong analytical skills and problem-solving abilities.

Strong teamwork skills and the ability to effectively communicate with all management levels.

Results oriented, independently goal directed, able to multi-task and meet established time frames.

Excellent customer service skills and must be able to work independently.

 

EDUCATION / LICENSURE:

High school diploma or GED required
Minimum of two years’ experience in a healthcare or clinical setting

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