What are the responsibilities and job description for the Referral Program Coordinator position at The University of Kansas Health System St. Francis Campus?
Overview
Join our team as a day shift, full-time, Referral Operations Referral Program Coordinator in Topeka, KS.
Why Join Us?
Thrive in a People-First Environment and Make Healthcare Better
- Thrive: We empower our team with career growth opportunities, tuition assistance, and resources that support your wellness, education, and financial well-being.
- People-First: We prioritize your well-being with paid time off, comprehensive health benefits, and a supportive, inclusive culture where you are valued and cared for.
- Make Healthcare Better: We use advanced technology to support our team and enhance patient care.
Get to Know Your Team:
- The University of Kansas Health System St. Francis Campus, a part of a rich legacy of compassionate care since 1909, now offers 378 licensed beds, a history of innovation, and strong community support.
Responsibilities
- Ensures current and standardized referral policies and workflows are followed and utilized on a regular basis.
- Prioritizes referrals by their urgency and addresses them in a timely manner.
- Participates and successfully completes required orientation and training related to job responsibilities.
- Ensures complete demographic, insurance information, and appropriate/pertaining clinical information is sent to referred specialists.
- Contacts insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis, and prognosis to insurance companies if deemed necessary to prove the medical necessity of services.
- Reviews details and expectations about the referral with ordering providers and patients. Requests new referrals to be ordered when applicable.
- Identifies and utilizes community resources; establishes relationships with servicing providers and personnel.
- Serves as point of contact for patients and specialists for any questions or concerns. Assist in problem-solving potential issues related to their referral due to language or social barriers. If unable to help, assist in finding the right point of contact to further help.
- Receive requests for prior authorization through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored.
- Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
- Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
- Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.
- Meets departmental goals for referral authorization processing, scheduling, and phone responsibilities.
- Meets individual productivity and accuracy requirements as determined by the Supervisor and/or Manager
- Cooperates and interacts with supervisors, peers, other departments, and all customer groups demonstrating commitment to service.
Qualifications
Job Requirements:
- High School Diploma or equivalent
- Two or more years of experience with Electronic Health Record (EHR).
