Job Information
Robert Half Referral Specialist in Trevose, Pennsylvania
Description
We are offering an opportunity for a Referral Specialist in the Healthcare, Hospitals, and Social Assistance industry. The role is based in Trevose, PA and is a contract position. The successful candidate will be primarily responsible for verifying, obtaining, reviewing, and accurately determining that all medical documentation received from physicians or referral sources meets all Local Coverage Determinations and regulatory requirements.
Responsibilities:
Perform insurance eligibility verification utilizing various methods, including portals and phone calls, to confirm insurance coverage and eligibility of products.
Obtain required documentation with regular communication via phone and fax to offices.
Examine received documents to verify compliance, completeness, and accuracy of data.
Confer with Physician/Provider offices and approvers to resolve identified discrepancies and ensure needed documents support the provided services.
Request/Submit and follow up for Prior Authorizations (PARs) and PCP referrals.
Generate communication to the appropriate personnel on new and revised documents, including Prescriptions and Pre-authorization requests.
Regularly communicate with Territory Managers, Physicians/Providers, Payors, and internal departments.
Update the customer database with detailed plan information when obtaining insurance policy information.
Appropriately update the customer database when obtaining Prescriptions, office notes, pre-authorizations, and other documents.
Notate all customer accounts with all actions taken in clear and detailed language.
Communicate Payor requirements as they are discovered.
Achieve defined Service Level Agreements (SLAs).
Quickly assess situations and respond appropriately; handle special requests in a sensitive, professional manner.
Requirements
Minimum Qualifications:
High School Diploma or equivalent work experience
Basic understanding of payor guidelines which includes reading, understanding and interpreting medical records, payor requirements etc
2+ years of work experience in insurance verification/referrals
Working knowledge of Microsoft Office suite, including working within Excel tabs and analyzing information
Strong multitasking, attention to detail, organizational and communication skills (written and verbally)
Working knowledge of all HIPAA guidelines/regulations and adherence to them
Ability to work well in a team environment
Preferred Qualifications:
Previous DME experience a plus
Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
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All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
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