Patient Referral Specialist

2 weeks ago

Encinitas, California, United States Cutiscare LLC Full time
Position Overview

At CutisCare LLC, we specialize in providing comprehensive management services for wound care and hyperbaric medicine across various healthcare facilities. As a Patient Referral Specialist, you will become an integral part of a dedicated team focused on enhancing the quality of life for patients during their recovery process. This role offers a full-time opportunity with a competitive benefits package, including medical, dental, vision, disability, life insurance, flexible spending accounts, a 401(k) match, and paid time off.

Key Responsibilities:
  • Insurance Verification: Conduct thorough checks to confirm patient insurance coverage and eligibility.
  • Referral Management: Efficiently process and monitor all incoming referrals, whether received via fax or electronically, ensuring all information is accurate and complete.
  • Patient Registration: Register and schedule patients in accordance with established hospital protocols.
  • Authorization Coordination: Secure necessary authorizations for wound care and hyperbaric services as prescribed by internal providers.
  • Outgoing Referrals: Manage the coordination of outgoing referrals and insurance authorizations for various services, including DME, home health, vascular, nutrition, imaging, and infusion.
  • Clinical Record Support: Ensure that clinical documentation meets medical necessity and insurance criteria for all requested services and procedures.
  • Billing Assistance: Collaborate with the hospital billing department to address claim denials and assist with appeals when required.
  • Effective Communication: Maintain professional and efficient communication with all stakeholders, including colleagues, referring providers, and patients.
  • Administrative Support: Provide front office assistance, including answering phones and managing patient check-in/out processes.
Qualifications:
  • High school diploma or equivalent.
  • Experience in a healthcare setting.
  • BLS certification is required.
  • Proficiency in insurance verifications and eligibility processes.
  • Knowledge of referrals, insurance authorizations, and pre-certifications.
  • Medical Assistant certification is preferred.
  • Familiarity with medical coding is advantageous.

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