What are the responsibilities and job description for the Referral Coordinator Lead position at Kaiser Permanente?
Job Summary:
Under limited supervision, analyzes, reviews and processes referrals for authorization of outside medical services for all referral type sand specialities, with specific responsbility for a subset of team members for a specific business/referral focus area.Researches and resolves inquiries from outside providers, educates members, physicians, outside providers and staff regarding the referral process, with specialized focus areas. Assist in training new hires. Updates and edits authorization into the Outside Medical Services system. Recommends changes/additions to enhance service levels and cost benefits.
Essential Responsibilities:
- Reviews, evaluates and processes each outside medical servies referrals for completeness, accurarcy and timeliness.
- Determines the appropriate coverages, service codes and providers to support financial reporting, obtain required approvals and issues notifications to complete each outside medical services referrals.
- Assist supervisor in coaching and mentoring of Referral Coordinators.
- Assist in the development of job aids,DLPs (desk level procedures) and training materials to support the examiners efficiency and knowledge.
- Process referrals for specific set of medical procedures, services and providers by following policies and procedures.
- Conducts referral report reviews, analysis, corrections and communications as part of the referral and authorization process.
- Prepares and delivers service reports to assigned areas (by specialty or medical center).
- Provide customer service to various referral process stakeholdrs (e.g. patient, provider, case manager, etc.) by responding to inquiries related to authorization and referrals.
- Collaborate with clinical case managers and case coordinators to ensure accurate and timely authorization processes. Inquire with referring providers when referral information requirements are not met.
- Act as a primary contact for medical center stakeholders and physicians.
- Ensure outside providers agreement are in place by confirming contract status or requesting letter for payment. Code referrals accurately to indicate any special claims handling requirements.
Qualifications:
Basic Qualifications:
Experience
- Two years experience as a referral coordinator or provider relations, claims coordinators, benefit analysis.
Education
- Associate degree OR four (4) years of experience in a directly related field, with demonstrated proficiency in medical terminology High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- Previous medical assistance, utilization management/authorization or coding experience in a hospital or clinic environment.
- Previous experience working with health information or medical records/database systems.
- Knowledge of medical terminology or medical coding.
- Excellent customer service, telephone presentation and problem solving skills.
- Ability to prioritize work in a high volume demanding environment.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Bachelors degree preferred.
- Proficiency in medical terminology, utilization management process, health plan benefit administration.
