Referral Coordinator

Referral Coordinator – AdventHealth Manchester

All the benefits and perks you need for you and your family:

• Benefits from Day One
• Paid Days Off from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full Time

Shift : Day; Monday – Friday; 8:00am – 5:00pm

Location: 509 Memorial Drive, Manchester KY, 40962 (Will also be expected to help cover in the call center if the need arises, willingness to flex job roles.)

The role you’ll contribute:

Direct reporting to the Patient Resource Supervisor. Is accountable for providing quality customer service & patient financial responsibilities to patients, referring physicians, visitors and internal customers by obtaining insurance pre-certification and benefit verification for imaging procedures. Develops and maintains positive relationships with physician's offices, patients, and sites while conveying accurate benefit and payment details in regard to any and all future visits. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value you’ll bring to the team:

• Possesses a strong knowledge, understanding, and competency in the areas of insurance carrier plans and coverage benefits, Local Coverage Determinations, Radiology procedures, CPT codes, HCPCS, and ICD-10 codes.
• Ensures pre-certification and verification of benefits has been obtained and clearly documented on all required exams 10 business days prior to patient’s procedure, or within 24 hours of scheduling, or same day add-ons determined at the time of scheduling.
• Works a minimum of 3 days out on verification of benefits.
• Determines if patient’s insurance is a part of the provider network
• Possesses a strong knowledge of required waivers or documents necessity (Ex: Medicare ABN’s, auto forms, clinical documents, EMRs, and orders).
• Makes outgoing calls or utilizes on-line recourses to obtain for pre-certification or any authorization required by the insurance carriers.
• Contacts patient or physician’s office using HIPAA guidelines prior to scheduled exam when additional information is required.
• Serves as an insurance expert in assisting customer service representatives, front desk associates, account representatives, center directors, and technologists in answering insurance related questions.
• Notifies patients, referring physicians, VIP specialists, site manager, and support staff with regard to appointment cancellations as a result of insurance denial, delay in obtaining insurance authorization while effectively explaining the reason for the denial or delay.
• Works as a liaison for site managers, hospital managers helping potentially fill next day’s schedule for CT/MR exams.
• Patient Refuse Referrals, Do not delete refused referrals. Document patient refusal, cancel-close referral.
• Weekly review of Open Status Referrals with Patient Resource Supervisor.

The expertise and experiences you’ll need to succeed:

Minimum qualifications:

• High School Diploma or equivalent

Preferred qualifications:

• Bachelor's
• Medical terminology and office background
• Understanding of Coinsurance, Co-pay’s and deductibles and the ability to explain

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Patient Financial Services

Organization: AdventHealth Manchester

Schedule: Full-time

Shift: 1 - Day

Req ID: 25014840

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.