Referral Coordinator

Department:

09121 AMG Buffalo Grove - Building Operations

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Monday-Friday 8:30AM-5:00PM

Pay Range

$21.45 - $32.20

Major Responsibilities:

• Coordination of the Referral Process
  •       1)Collects all referrals from medical staff daily and obtains any necessary approvals from attendings.
  •     2)Works in all aspects of the referral process, including processing referrals for patients based on primary care physician orders and follow up specialists service recommended.
  •     3)Generates necessary correspondence or calls to patients, physicians and office staff, managed care organizations or vendors requesting additional information and requirements for referral authorization.
  •     4)Communicates with appropriate Physician, nursing staff and patients regarding follow-up status of referrals.
  •     5)Prepare correspondence, input referral information in the automated system, collects additional medical necessity supporting documentation and provide to appropriate parties for approval.
  •     6)Attend PHO and other vendor meetings as required to discuss changes in processing requirements.
  •  7)Identifies potential problems (i.e., labs, x-rays, procedures, and other physicians) with payment of charges from referral by communication with PHO and other managed care specialists.
• Reviews all payor requirements by type of service and organizes materials to ensure appropriate referral and that steps are followed to avoid claims denials.
  •     1)Investigates diagnosis codes and medical necessity guidelines to determine if appropriate based on payor guidelines.
  •     2)Discusses any discrepancies with physician for correct coding of referral.
  •     3)Provide correct codes both ICD9 and CPT and explains coverage to ordering physician.
  •     4)Input codes into automated system and discuss any certification requirements with vendor’s nurse certification specialist.
  •     5)Monitors approval status and resubmit request as necessary.
  •     6)Identifies need for appeal process with insurance companies and Medicare and initiates process.
• Participate in education and eligibility problem resolution.
  •     1)Works with attendings and nurses in the education of physician office staff on referral procedures.
  •     2)Acts as a resource to customers and help resolve referrals, claims and eligibility issues.
  •     3)Communication with manager, program director, other health care professionals, and various staff in a positive fashion in order to promote patient satisfaction, quality services delivered and resolution of issues.
  •     4)Verify eligibility of patients including problem resolution with Advocate MSO and various managed care organizations.
  •     5)Identifies and maintains appropriate communication with supervisor involving problems and observations in course of daily operations.
  •     6)Other duties as needed.
• Establish controls and a tickler system set-up to see if services are obtained. Maintain tracker to ensure:
  •     1)Patient received the services ordered before termination of the referral.
  •     2)Patient have proper paperwork before going to the referral site.
  •     3)Results are received from the specialist prior to the patient’s next appointment.
  •     4)Respond as needed to same day request from patient, if patient urgently needed to see a specialist or forgot paperwork.
• Assures that referral documentation is filed in the medical record and physician sees clinical results of the referrals based on a tracking system put in place.
  •     1)Collect all faxed or mailed in consultant reports for referred patients.
  •     2)Sort and place in physician mail boxes for review with patient chart.
  •     3)Assure that physician has signed off acknowledging review.
  •     4)File data in patient chart and re-file the record in the medical records file room.

Education/Experience Required:

• H.S. diploma or G.E.D.
• 3-4 years experience in a managed care organization, hospital or physic