Referral Coordinator III - Digestive Health Institute ORMC

Referral Coordinator

The Referral Coordinator supports Clinical teams, Patients and Family Members by managing referrals and/or authorizations for the Medical Group. They are responsible for processing Internal and External referrals and authorizations from orders prescribed, by the provider, in the Electronic Health Record (EHR) system within the Outpatient Ambulatory setting.

Essential Functions:

• Completes entry of referrals and/or authorizations into EHR
• Coordinates follow-up care with the referral as the referral expires
• Responsible to schedule various appointments associated with the referral, diagnostic testing and surgical procedures
• Ensures financial information and insurance has been verified
• Ensures Primary Care provider is accurate based on payer guidelines
• Updates patient insurance information in EHR systems as needed
• Initiates the referral and authorization process for visits and services
• Works closely with nursing and medical staff to facilitate optimal patient care
• Communicates with the scheduling department to verify each patient's insurance requirements have been satisfied for upcoming appointments
• Coordinates with other departments as needed to facilitate patient's visit
• Coordinates with Patients when necessary to complete referral
• Provides peer-to-peer training
• Acts as a resource for new hire preceptor and training
• Provides patient with referral information for physicians and facilities
• Communicates effectively with all internal and external customers PCP, Patient, clinical departments, etc. in order to obtain the required authorization needed for each visit or service
• Maintain working knowledge of ICD-10 and CPT codes
• Cross-trained with appropriate knowledge and skills necessary to staff all referral areas of specialty. Including but not limited to Diagnostic Authorizations, Treatment Authorizations, Surgical Procedures, in-office procedures
• Maintains current knowledge of referral and authorization requirements based on payer specific guidelines
• Demonstrates a basic knowledge of third party reimbursement requirements and regulations
• Exhibits competency in the use of registration systems, electronic verification tools and Web-based resources
• Serves as a resource for the department of referring provider options
• Understands the importance Orlando Health places on providing exemplary customer service
• Performs job in a manner that helps meet customer service goals
• Performs the duties of a system super user
• Serves as a resource during the implementation of new process improvements
• Works department reports as assigned
• Follow up on denial of services related to referral/authorization
• Exhibits knowledge to lead the team in absence of the manager
• Meets departmental goals regarding productivity and customer service
• Performs productivity audits to enhance user workflow
• Demonstrates a positive and professional approach and communicates effectively with customers and team members at all times
• Contributes suggestions for improving workflow and productivity
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards
• Maintains flexibility in work schedule availability that allows department to change/modify work schedule to meet departmental needs
• Maintains compliance with all Orlando Health policies and procedures
• Serves as an assistant to Supervisor and/or Manager of the department
• Assists Information Services and Clinical Informatics escalating all technical issues to troubleshoot issues for the team
• Promotes optimization of Patient Access processes and standardization of workflows with associated workgroups
• Assumes responsibility for professional development and education
• Attends and participates in department staff meetings and other meetings as assigned
• Responsible for maintaining performance measures as outlined by the department's productivity guidelines
• Compile monthly user reports to evaluate referring patterns
• Other duties as assigned

Qualifications:

• Education/Training: High School Diploma or equivalent
• Medical Terminology
• Critical Thinking Ability towards troubleshooting and issue resolution
• Medical office experience
• Previous experience in processing physician office and/or hospital referrals
• Proficient in Windows Microsoft Office based products (Word, Excel, and Power Point)
• Proficient in PC/Windows experience