Referral Coordinator

Description

 SUMMARY
Processes referrals to Specialist through to completion. Ensures accurate, timely review and processing of authorizations. 

DUTIES & RESPONSIBILITIES

• Receives and Processes incoming referral requests daily.
• Reviews referral orders for accuracy of codes and supporting documentation.
• Receives, processes, and verifies accuracy of authorizations.
• Receives and processes specialty notes to primary care physician to facilitate on-going authorizations for continued care.
• Serves as liaison and authorization resource to clinic staff, outside medical groups, and patients.
• Ensures pre-visit information is sent to patients as needed.
• Utilizes exceptional customer service skills in performing duties and assists with problematic referral and authorization process. 
• Recommends improvements to department processes as appropriate.
• Contacts insurance company(s) to verify patient eligibility if needed.
• Contacts patients as needed to update demographics. Informs patients/guarantors of their financial responsibility for scheduled services.
• Informs patients and/or clinic the staff of any insurance problems affecting future services.
• Develops and maintains professional working relationships with outside providers, vendors and insurance groups involved in the referral process. 
• Maintains an accurate and up-to-date tracking system for referrals and authorizations. Prepares reports regularly.
• Maintains current referral forms and insurance resource materials.
• Performs general clerical duties including, but not limited to, typing, answering the telephone, monitoring incoming faxes and assisting scheduling department.
• Other duties as assigned. 

Requirements

MINIMUM QUALIFICATIONS

• Education/Certification
• High School Diploma or GED.
• One year experience in an Ambulatory Care setting. 

Skills/Experience

• Demonstrated problem solving and time management skills.
• Computer Skills with high data entry accuracy.
• Demonstrated organizational and prioritization skills.
• Knowledgeable of referral, payor sources and authorization processes. 
• Knowledge of CPT and diagnosis codes.
• High level data entry and detail oriented.
• Excellent Communication skills to effectively communicate with members, physicians, co-workers and supervisors.

Preferred Qualifications

• Experience as a referral coordinator in an Ambulatory Health Care setting.
• Experience with electronic health records.
• Bilingual