Referral Specialist

ABC Home Medical Supply, Inc is one of the nation's leading urological supply providers and serves as a one-stop shop with a comprehensive line of medical supplies and service that includes: Urological, Incontinence, Wound Care, and Ostomy. ABC Medical is part of the JDS, Inc family of businesses. Our service companies possess the knowledge and expertise to deliver first-class products and personalized home healthcare services.

Location: Trevose
Department:

Summary:

The Referral Specialist is responsible for verifying, obtaining, reviewing, and accurately determining that all medical documentation received from physicians or referral sources meet all Local Coverage Determinnations and regulatory requirements. The Referral Specialist is responsible for the Pre-authorization functionality.

Location:

In Office - Trevose, PA

Responsibilites:

Include the following as well as other duties and responsibilities, which may be assigned.
Examine documents to verify required compliance, completeness, and accuracy of data. Confer with document originator and approvers to resolve identified discrepancies. Contact insurance companies to confirm insurance coverage and eligibility of products. Obtain prior authorization and/or referrals. Appropriately update customer database when obtaining documents and pre-authorizations. Appropriately update document databases, and corresponding files. Generate communication to the appropriate personal on new and revised documents including Pre-authorization request. Regularly communicate with internal and external partners, including Customer Service, Referral Management, Sales, and Payors. Achieve defined Service Leval Agreements. Communicate Payor requirements as they are discovered. Adheres to all HIPAA guidelines/regulations. Follows company policies and procedures.

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

Job Req ID: 32895

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