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Referral Specilist

Universal Health Services


Location:
MC ALLEN, TX
Date:
03/21/2017
Job Code:
211528
Universal Health Services
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Job Details





Referral Specilist

Job Code:  211528
Facility: Valley Care Clinics
Location: MC ALLEN, TX US
Region:
Travel Involved: 0-10%
Job Type: Full Time
Job Level:  Experienced (Non-Manager)
Minimum Education Required: High School or equivalent 
Skills:  
Category: Allied Health
FTE: 1.0
Position Summary:


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

 
Requirements

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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