About the position
ABC Home Medical Supply, Inc is seeking a Referral Specialist to join our team in Port Saint Lucie, FL. As one of the nation's leading urological supply providers, we pride ourselves on delivering first-class products and personalized home healthcare services. The Referral Specialist will play a crucial role in ensuring that all medical documentation received from physicians or referral sources meets Local Coverage Determinations and regulatory requirements. This position requires a detail-oriented individual who can verify, obtain, review, and accurately determine the compliance of medical documentation. The Referral Specialist will be responsible for the pre-authorization functionality, which includes performing insurance eligibility verification through various methods such as portals and phone calls. Regular communication with physician/provider offices and payors is essential to resolve discrepancies and ensure that all necessary documents support the services provided. The role also involves generating communication regarding new and revised documents, updating customer databases with detailed plan information, and achieving defined service level agreements (SLAs). This position requires a strong ability to multitask, attention to detail, and excellent organizational and communication skills. The Referral Specialist will work closely with Territory Managers, Physician/Providers, and internal departments to ensure a seamless process for our customers. The work schedule includes onsite work Monday and Tuesday, with the option to work from home Wednesday through Friday, from 8:30 am to 5 pm CST.
Responsibilities
- Verify, obtain, review, and accurately determine that all medical documentation received meets Local Coverage Determinations and regulatory requirements.
- Perform insurance eligibility verification utilizing various methods including portals and phone calls.
- 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 discrepancies and ensure needed documents support services provided.
- Request/Submit and follow up for Prior Authorizations (PARs) and PCP referrals.
- Generate communication to appropriate personnel on new and revised documents including Prescriptions and Pre-authorization requests.
- Regularly communicate with Territory Managers, Physician/Providers, Payors, and internal departments.
- Update customer database with detailed plan information when obtaining insurance policy information.
- Notate all customer accounts with actions taken in clear and detailed language.
- Communicate Payor requirements as they are discovered.
- Achieve defined SLAs.
- Quickly assess situations and respond appropriately; handle special requests in a sensitive, professional manner.
Requirements
- High School Diploma or equivalent work experience.
- Basic understanding of payor guidelines, including reading, understanding, and interpreting medical records and payor requirements.
- 2+ years of work experience in insurance verification/referrals.
- Working knowledge of Microsoft Office suite, including Excel.
- Strong multitasking, attention to detail, organizational, and communication skills (written and verbal).
- Working knowledge of all HIPAA guidelines/regulations and adherence to them.
- Ability to work well in a team environment.
Nice-to-haves
- Previous DME experience.
- Medical Assistant experience.
Benefits
- Variety of Medical, Dental and Vision Insurance Plans
- 401k Plan with Company Match
- PTO and Paid Holidays
- EAP
- Employee Discounts
