Referral Coordinator

Position Purpose: This position will be a key member of PrimaCARE, P.C. Referral Department

• Serves as liaison between members of specific health plans and primary care providers and specialists to coordinate referrals and help members and providers navigate the PrimaCARE, P.C. Provider Network
• Creates and processes referrals
• Uses a referral data tool to manage and retain care within the PrimaCARE, P.C. network
• Ensures accurate and timely processing of all requests
• Receives incoming requests from physician practices and patients
• Verifies eligibility and coverage
• Communicates with physician practices and patients as needed
• Confirms referrals with physician practices and patients
• Assures that all necessary documentation occurs in a timely manner
• Achieves established performance targets
• Meets established quality expectations, e.g., confidentiality, accuracy, customer service, and professionalism
• Verify and update patients’ insurances
• Assist in updating Providers in electronic medical records system (NPI, Provider Name, Address, etc.)
• Upload hard copy of Insurance Referrals from carriers
• Submit and follow up all Out of Network Insurance request
• Supports other departmental team members to ensure turnaround time expectations are met.
• Communicates important information to team members
• Contributes to team efforts to improve workflow and efficiency
• Provides Outstanding Customer Service, going the “extra mile” to assure that customer expectations are met
• Assists with other projects within the department on an "as needed" basis
• Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment
• Commits to recognize and respect cultural diversity for all customers (internal and external)
• Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs, and ages, utilizing interpreters when needed
• Performs other duties as assigned

Education / Experience / Other Requirements

Specialized Knowledge:

• Exceptional Customer Service
• Strong communication and interpersonal skills; particularly in intense situations
• Ability to meet deadlines in a high-pressure environment
• Knowledge of managed care concepts and medical terminology
• Ability to multi-task and work with multiple software applications
• Knowledge of insurance, medical office practice, and/or referral processing
• Demonstrated ability to process insurance referrals and/or schedule physician appointments
• Excellent organizational skills and attention to detail
• Customer service focused
• Demonstrated understanding of the need for patient confidentiality in a HIPAA-compliant environment.
• Self-motivated and reliable
• Demonstrated ability to work independently and as part of a team.
• Knowledge of 3rd party payers

This position is subject to the COVID-19 Vaccination Policy. Employees in this position will be required to provide adequate proof of vaccination for COVID-19 by an FDA-approved vaccine prior to starting work. Exemptions from this vaccine requirement on the basis of medical condition or sincerely held religious belief in accordance with applicable Federal laws.

PrimaCARE, P.C. is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.