Referral Specialist - NVISION Eye Centers

NVISION® Eye Centers is one of the largest ophthalmology providers in the U.S., with over eighty centers across six states including California, Nevada, Oregon, Arizona, Texas, and Utah. An innovative leader in ophthalmology, we are dedicated to providing the best patient experience through the use of the latest technology and treatment by the most talented and experienced surgeons in the industry. With more than 3,000 eye doctors referring their patients and trusting their own eyes to NVISION surgeons, NVISION Eye Centers is the Eye Doctors' #1 Choice®.

The Referral Specialist position is primarily responsible for serving as a liaison for patient resources and help with setting appointment and processing transfers. This position works closely with insurance companies and must be executed in compliance with insurance requirements.

• Accurately identify/verify HMO plans using EHR and other insurance portals
• Submit referral/authorization requests to primary care providers/insurance companies for inbound and outbound requests
• Accurately  efficiently obtain insurance, eligibility, and submit procedure authorizations via web, fax, or phone
• Gather and verify demographic data and provide patients with pertinent insurance information and estimate of benefits
• Efficiently manage incoming/outgoing phone calls, voice messages, and portal messages
• Accurately document insurance information, communications and action taken in patient charts
• Troubleshoot missing, incorrect, or out of network insurance issues as appropriate
• Maintain documentation and tracking of insurance approvals and denials, communication, and coordinating with physicians, staff, and patient
• Process related incoming faxes and monitor successful delivery of sent faxes
• Maintain and report accurate data to indicate number of daily/weekly/monthly referrals worked
• Follow up in a timely manner on referral status updates, voicemails and emails pertaining to referrals
• Import vital documents into the patient's record pertaining to referrals
• Communicate timely with patients regarding any referral/insurance questions and providing initial notification once referral received
• Schedule patient appointments when necessary once referral received
• Provide support for benefit verification when needed including the "Insurance Hotline" when necessary.
• Provides support for referral coordinator
• Other duties may be assigned

EXPERIENCE AND OR LICENSE/CERTIFICATION

• High school diploma or equivalent GED required.
• 1+ years’ experience working with insurance companies and processing referrals.

SPECIAL SKILLS, KNOWLEDGE AND ABILITIES

• Knowledge of provider enrollment and credentialing processes as required by health plans
• Ability to work independently with minimal supervision
• Must have strong organizational and time management skills
• Ability to work on multiple projects and meet tight deadlines
• Understanding of medical terminology
• Excellent problem-solving skills with ability to make sound judgments in a timely manner
• Able to work independently and manage time, balancing need for high level of accuracy with appropriate sense of urgency

COMPUTER SKILLS

• Ability to utilize computer software, including proficiency in navigating electronic health records and appropriate documentation