Referral Specialist - Nashville, TN

ABC Home Medical Supply, Inc is oneof the nation's leading urological supply providers andserves as a one-stopshop 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: Nashville

Department:

Work Location:Remote until Nashville office is open in Q1 2025; Nashville office with hybrid work with 3 days in the office

Work Hours: 8:30am-5pm CST

Responsibilities:

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

• Perform insurance eligibility verification utilizing various methods including portals and phone calls to confirm insurance coverage and eligibility of products. Obtain required documentation with regular communication via phone and fax to offices.
• Examine received documents to verify required compliance, completeness, and accuracy of data.
• Confer with Physician/Provider offices and approvers to resolve identified discrepancies and ensure that the needed documents support the services we are providing.
• Request/Submit and follow up for Prior Authorizations (PARs) and PCP referrals.
• Generate communication to the appropriate personal on new and revised documents including Prescriptions and Pre-authorization request.
• Regularly communicate with Territory Manager's Physician/Providers, Payors, and internal departments.
• Update customer database with detailed plan information when obtaining insurance policy information.
• Appropriately update customer database when obtaining Prescriptions, office notes, pre-authorizations, and other documents.
• Notate all customer accounts with all actions taken in clear and detailed language.
• Communicate Payor requirements as they are discovered.
• Achieve defined SLA's.
• Quickly assess situations and respond appropriately; handle special requests in a sensitive, professional manner.

Minimum Qualifications:

• High School Diploma or equivalent required.
• Basic understanding of payor guidelines which includes reading, understanding and interpreting medical records, payor requirements etc
• 2+ years of work experience in insurance verification/referrals
• Working knowledge of Microsoft Office suite, including working within Excel tabs and analyzing information
• Strong multitasking, attention to detail, organizational and communication skills (written and verbally)
• Working knowledge of all HIPAA guidelines/regulations and adherence to them
• Ability to work well in a team environment

Preferred Qualifications:

• Previous DME experience a plus
• Medical Assistant experience

Here's what we have to offer:

• Variety of Medical, Dental and Vision Insurance Plans
• 401k Plan with Company Match
• PTO and Paid Holidays
• EAP
• Employee Discounts

Job Req ID: 33321

EOE Statement:

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Accommodations Statement:

ABC Medical endeavors to make www.abc-med.com accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the ABC Medical HR Department at HR@abc-med.com. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.