Referral Coordinator (CC26159 - NIC)

Medical Referral Coordinator

Responsible for answering telephones, scheduling appointments and providing exemplary customer service. Processes referrals for Adult Medicine, Pediatric, Medical Specialty and Behavioral Health providers. Performs verification of insurance coverage and benefits, and obtains authorization for treatment as required by insurance plan, according to third party payer guidelines. Documents referral/authorization information and communication in Electronic Health Record (EHR) system.

DUTIES AND RESPONSIBILITIES:

1. Schedules patient appointments utilizing established provider templates. Ensures patient demographics and insurance information in the EHR is complete, accurate and up to date. Works cohesively and interdepartmentally with providers and support staff to optimize templates; performs patient schedule changes as needed. Documents and relays information with external providers as appropriate to facilitate patient care.

2. Demonstrates appropriate telephone etiquette according to the policies and procedures of the department, and provides prompt and courteous service upon each telephone call received. Proactively participates in the implementation of new initiatives and processes. Suggests improvements in call flow processes and communication as needed; participates in organized efforts to continuously improve service excellence levels.

3. Follows the Center's policies and procedures pertaining to patient privacy and protected health information. Reports any potential breach of privacy, HIPAA violation or suspicious behavior or activity relating to patient health records to supervisor or other appropriate chain of command.

4. Processes referrals according to the oldest date ordered and level of urgency, tracks and manages referrals throughout every stage to avoid backlog and ensure completion, and maintains consistent channel of communication between staff, providers and patients.

5. Coordinates between patient, PCP and specialty provider for appointment scheduling; informs provider and/or supervisor of unusual delay, insurance issue or other problem with completing referral in a timely manner.

6. Notifies patient of reasoning for incomplete processing and provides feedback for referral via messaging system or telephone call; provides additional instructions as needed.

7. Provides excellent internal/external customer service via telephone, messaging system and fax contact to assist patients with their healthcare needs.

8. Performs other related duties as assigned.

JOB QUALIFICATIONS:

High School graduate or equivalent required

Medical referral experience preferred

Minimum of one year of experience in customer service, preferably in a healthcare setting

Experience with EMR/EHR and medical terminology preferred

Excellent oral and written communication and interpersonal skills

Experience with insurance verification and healthcare billing preferred

Proficient in the use of personal computers, including Microsoft Word, Excel and Outlook

Ability to handle multiple tasks efficiently with minimal supervision

Bilingual in English and Spanish preferred

Scheduled hours and/or work locations are subject to change

PHYSICAL ACTIVITIES AND REQUIREMENTS:

Finger Dexterity: Using fingers to make small movements such as typing or picking up small objects.

Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.

Hearing: Able to hear average or normal conversations and receive ordinary information.

Repetitive Motions: Frequently and regularly using the wrists, hands, and fingers.

Visual: Average, ordinary, visual acuity necessary to prepare or inspect documents or other materials.

Physical: Physical work involving bending, stooping, standing most of the time. May have to lift folders, files, papers, equipment, and other such items weighing up to approximately 25 lbs. Ability to sit for long periods.

Qualifications

Education: High School/GED or better in General Business.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.