Referral Coordinator

Position Summary: Coordinates all aspects of the outpatient/inpatient referral and precertification process including medical necessity review, benefits eligibility review, data entry and provider correspondence.

Essential Duties and Responsibilities:

• Coordinates and reviews emergency and nonemergency appointments and scheduled procedures and/or surgeries with patient, physician and/or facility prior to appointment or procedure.
• Obtains missing information including name, insurance provider, and contact telephone numbers.
• Processes referrals following section guidelines and established procedures including ICD 9 codes and procedure codes as required and obtains authorization/precertification from insurance carriers.
• Reviews and processes insurance and provider correspondence.
• identifies, tracks, and resolves on-going problems with the authorization process.
• Establishes and maintains pre-authorization files.
• Receives patient requests and determines authorization requirements.
• Answers referral questions and inquiries by phone and in person regarding referrals to a specialist or treatment facility.
• Contacts patients to inform them of referral or precertification appointment; answer patients' referral billing questions.
• Works with the manager to formulate a plan for professional development.
• Attends educational in-services as appropriate.
• Enters patient and referral information into computer systems following section/ department guidelines and established procedures.
• Verifies information for accuracy and completeness.
• Performs Medical Receptionist duties as required.
• Performs other related duties as required.

Competencies: To perform the job successfully, an individual should demonstrate the following: clerical duties including, but not limited to: data entry, photocopying, faxing, filing, typing letters, preparing envelopes and forms, assisting on vendor relations, mailing appointment reminder postcards, and maintaining office equipment in order to perform duties.

Communications - Exhibits good listening and comprehension. Expresses ideas and thoughts in written form. Expresses ideas and thoughts verbally. Keeps others adequately informed. Selects and uses appropriate communication methods.

Customer Service - Displays courtesy and sensitivity. Manages difficult or emotional customer situations. Meets commitments. Responds promptly to customer needs. Solicits customer feedback to improve service.

Dependability - Commits to doing the best job possible. Follows instructions, responds to management direction. Keeps commitments, Meets attendance and punctuality guidelines. Responds to requests for service and assistance. Takes responsibility for own actions.

Planning & Organization - Integrates changes smoothly. Plans for additional resources. Prioritizes and plans work activities. Sets goals and objectives. Uses time efficiently. Works in an organized manner.

Quality - Applies feedback to improve performance. Demonstrates accuracy and thoroughness. Displays commitment to excellence. Look for ways to improve and promote quality. Monitors own work to ensure quality.

Teamwork - Balances team and individual responsibilities. Contributes to building a positive team spirit. Exhibits objectivity and openness to others' views. Gives and welcomes feedback. Puts the success of the team above their own interests.

Use of Technology - Adapts to new technologies. Demonstrates required skills. Keeps technical skills up to date. Troubleshoots technological problems. Uses technology to increase productivity.

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience:

High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.

Language Ability:

Read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Write routine reports and correspondence. Speak effectively before groups of customers or employees.

Mathematical Ability:

Add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals. Compute rate, ratio and percent, and draw and interpret bar graphs.

Reasoning Ability:

Apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Deal with problems involving several concrete variables in standardized situations.

Computer Skills:

Microsoft Office Suite

Certificates and Licenses:

HIPAA Certified

Supervisory Responsibilities: This position does not have supervisory responsibilities.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Typical busy office environment with moderate noise level. Frequent interruptions. Required to travel to multiple office locations as needed within region.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Frequent sitting and standing from a sitting position. Use of keyboard and/or computer mouse up to 8-hours per day. Ability to lift 20lbs. Vision abilities include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

Salary : $21 - $24