Referral Coordinator II

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 and new hire preceptor.
• 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.
• 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.
• 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.
• Basic understanding of how the referral role affects the Organization's Initiatives and goals.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions:

• 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.

Qualifications:

• Education/Training: High school graduate. Medical Terminology.
• Experience: Three (3) years of directly related work experience. 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.