Referral Coordinator

Job Summary
The Referral Coordinator plays a crucial role in ensuring that patients receive the necessary referrals for specialized care. This position requires strong organizational skills, attention to detail, and a comprehensive understanding of medical terminology and insurance processes. The ideal candidate will facilitate communication between patients, healthcare providers, and insurance companies to ensure a seamless referral process.

Key Responsibilities:

1. Referral Management and Coordination:

• Process Referral Requests: Process referral requests from healthcare providers within the practice or from external sources. This includes reviewing referral forms to ensure they are complete and accurate.
• Schedule Appointments: Contact specialists to arrange appointments for referred patients. Ensure that appointment times are communicated clearly to the patient and all involved parties.
• Track Referral Status: Monitor the status of each referral, ensuring that patients are seen promptly. Follow up on any pending referrals to ensure timely processing.
• Communicate with Patients: Provide patients with all necessary information about their referrals, including appointment dates, location, specialist details, and any pre-appointment instructions.

2. Insurance Verification and Authorization:

• Verify Insurance Coverage: Contact insurance companies to confirm coverage and benefits for specialist visits, and other referral-related services.
• Obtain Pre-Authorization: Submit referral documents to insurance companies to obtain pre-authorization for specialist care or procedures when required. Follow up with insurance providers to ensure timely approval.
• Document Authorization Details: Maintain detailed records of insurance approvals and denials, including the date of approval/denial, the insurance representative's name, and any relevant policy numbers. Ensure that all authorizations are updated in the patient’s file.

3. Documentation and Recordkeeping:

• Maintain Referral Logs: Keep detailed logs of all referral activities, including dates of referral, appointments scheduled, specialist feedback, and insurance information. Ensure that all logs are updated daily.
• Update Patient Files: Ensure that all referral-related documents (e.g., referral forms, insurance approvals, specialists' reports) are correctly entered into the Electronic Health Record (EHR) system and physical patient files.

4. Communication and Liaison Duties:

• Internal Communication: Work closely with physicians, nurse practitioners, and office staff to discuss patient care needs, provide updates on referrals, and facilitate the coordination of care.
• External Communication: Act as the primary point of contact between the practice and external specialists. Ensure that specialists have all necessary referral documentation and patient information to provide appropriate care.
• Assist with Patient Inquiries: Address patient questions regarding referral procedures, insurance issues, and appointment logistics. Provide clear and helpful guidance on how to navigate the referral process.

5. Follow-Up and Monitoring:

• Track Referral Outcomes: Monitor the outcomes of referrals, ensuring that patients receive appropriate follow-up care and feedback from specialists. If patients fail to attend their scheduled appointments, follow up with them to reschedule.
• Manage Delays: If there are delays in obtaining insurance approval, scheduling appointments, or receiving necessary documentation, promptly address and resolve issues with the appropriate parties.
• Coordinate Test Results and Feedback: Ensure that results from referred tests or specialist consultations are received, reviewed, and communicated to the referring physician and patient in a timely manner.

6. Compliance and Best Practices:

• Ensure HIPAA Compliance: Maintain confidentiality of patient information in compliance with HIPAA regulations. Safeguard all medical records, insurance details, and personal health information from unauthorized access.
• Stay Informed on Insurance Policies: Continuously update knowledge of insurance plans, policies, and referral procedures to ensure smooth interactions with insurance companies and minimize claim rejections.
• Adhere to Office Protocols: Follow office protocols, including the use of electronic health records (EHR), referral tracking software, and standard operating procedures for referrals, to ensure consistent, high-quality service.

7. Problem-Solving and Conflict Resolution:

• Collaborate with Team Members: Work closely with other office staff, including receptionists, billing staff, and clinical personnel, to ensure that all aspects of the referral process are completed accurately and efficiently.

Requirements

• Proficiency in medical terminology and understanding of medical records management.
• Experience in insurance verification processes and familiarity with managed care systems.
• Knowledge of medical coding practices (ICD-9, ICD-10) is preferred.
• Previous experience in a medical office or dental office setting is a plus.
• Strong organizational skills with the ability to manage multiple tasks simultaneously.
• Excellent communication skills, both verbal and written, to interact effectively with patients and healthcare providers.
• Attention to detail is essential for maintaining accurate records and processing referrals efficiently.

Job Type: Full-time

Pay: $14.00 - $16.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $14 - $16