Muscp – Referral Management Specialist

Job Description Summary

Obtains and processes signed physician orders/referrals to ensure accurate clinical documentation for care delivery, specialty and outpatient ancillary referrals. In addition, the referral coordinator will conduct online insurance eligibility/benefit verification, obtain pre-certification/authorization, referral clearance and financial education on designated cases. As appropriate; notifies patient/guarantor, specialist, referring provider, etc., with pertinent information, inclusive of, but not limited to clinical documentation, referral status, follow-up, etc.

Entity

MUSC Health Partners (MHP)

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC005335 CFC COMM MUSC Health Atlantic Cardiovascular Associates

Pay Rate Type

Hourly

Pay Grade

Health-19

Scheduled Weekly Hours

40

Work Shift

Job Description

• Upon receipt of referral from the MUSC Physicians Primary Care offices, processes referrals by scheduling appointments for specialists and diagnostic testing utilizing Epic to schedule or by contacting the departments. Communicate appointment information to include appointment date, time and location with the patient. Send mychart messages and mail correspondence related to scheduling when needed. Process external referrals by sending the patient’s referral and medical records to the external providers. Tracking referral to verify patient’s appointment with the community provider.
• Contacts the insurance carriers to obtain pre-certification approval as required for appointments. In the case of pre-certification denials, the providers and patients are notified. Documents all communications, scanning and pre-certification documents in the patient’s referral for tracking purposes. 
• Closing the loop with PCMH, patients must be contacted after any no showed and canceled appointment to reschedule their appointment.
• Follow up on pending referrals in a timely manner.

• Act as liaison between MUSC providers, insurance companies, patients and external providers to ensure appointment access. This role triages patient calls/messages, provider/office staff calls and inbasket messages according to established protocol to answers questions, resolves issues and refer to appropriate departmental contact as needed to ensure a positive overall patient experience.
• Answer multi-line telephone, handle calls appropriately, filing and make copies.
• Responsible for maintaining adequate inventory of office supplies with the approval of the Referral Manager.
• Perform Referral Specialist duties as assigned by Referral Manager and maintain departmental protocol.

Additional Job Description

Required Minimum Training and Education: High School Degree or Equivalent Work Experience: 0-6months

Required Licensure, Certifications, Registrations: n/a

Physical Requirements: Continuous requirements are to perform job functions while standing, walking and sitting. Ability to bend at the waist, kneel, climb stairs, reach in all directions, fully use both hands and legs, possess good finger dexterity, perform repetitive motions with hands/wrists/elbows and shoulders, reach in all directions. Maintain 20/40 vision corrected, see and recognize objects close at hand and at a distance, work in a latex safe environment and work indoors.  Frequently lift and/or carry objects weighing 20 lbs (+/-) unassisted. Lift from 36" to overhead 15 lbs.  Infrequently work in dusty areas and confined/cramped spaces.

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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