Referral Specialist

SUMMARY:

The HCP Specialist is responsible for verifying, obtaining, reviewing, and accurately determining that all medical documentation received from physicians or referral sources meet all LCD’s and regulatory requirements. The HCP Specialist is responsible for the Pre-authorization functionality.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Include the following as well as other duties and responsibilities, which may be assigned.

1. Examine documents to verify required compliance, completeness, and accuracy of data.
2. Confer with document originator and approvers to resolve identified discrepancies.
3. Contact insurance companies to confirm insurance coverage and eligibility of products.
4. Obtain prior authorization and/or referrals.
5. Appropriately update customer database when obtaining documents and pre-authorizations.
6. Appropriately update document databases, and corresponding files.
7. Generate communication to the appropriate personal on new and revised documents including Pre-authorization request.
8. Regularly communicate with HCP, RSM’s and payors.
9. Achieve defined SLA’s.
10. Communicate Payor requirements as they are discovered.
11. Adheres to all HIPAA guidelines/regulations.
12. Follows company policies and procedures.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and must possess the ability to: Build strong relationships and interact professionally and ethically with patients, caregivers, RSM’s and Healthcare Professionals; handle multiple tasks simultaneously; provide clear, concise oral and written directives/communications; quickly assess situations and respond appropriately; handle special requests in a sensitive, professional manner. Strong Perform strong organizational and time management tasks. Have detail-oriented work product. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE:

1. High School Diploma or equivalent work experience.
2. Basic understanding of payor guidelines.
3. Analytical skills required, attention to detail, and organized.
4. 2+ years of work experience
5. Previous DME experience a plus.
6. Basic Microsoft skills.
7. Ability to work well in a team environment

TRAINING:

Our industry is a highly regulated industry, and because of that and our commitment to providing the best in class products, services, and support, we require ALL employees to complete the following training programs prior to the marketing and promotion of our products, services, and support systems:

1. Anti-Kick Back Training
2. Fraud, Abuse, and Waste Training
3. HIPPA Training
4. Systems Training