Referral Coordinator I

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.
• Completes registration and obtains insurance authorization for new patients, diagnostic testing and for hospital diagnostics.
• Coordinates follow-up care with the referral as the referral expires.
• Ensures financial information and insurance is current and active.
• Ensures Primary Care provider is accurate based on payer guidelines.
• Updates patient insurance information in EHR systems as needed.
• Transcribes faxed referral requests via On-Base fax system into EHR.
• Initiates the referral and authorization process for visits and services.
• Works closely with clinical teams to facilitate optimal patient care.
• Coordinates with scheduling departments, and other departments as needed to facilitate patient's visit.
• Coordinates with Patients when necessary to complete referral.
• Provides patient with referral information for physicians and facilities.
• Communicates effectively with all internal and external customers – PCP, Patient, clinical departments, etc. to obtain the required authorization needed for each visit or service.
• Maintains current knowledge of referral and authorization requirements based on payer specific guidelines.
• Maintain working knowledge of ICD-10 and CPT codes.
• 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.
• 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.
• Maintains flexibility in work schedule availability that allows department to change/modify work schedule to meet departmental needs.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions:

• 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
• Licensure/Certification: None
• Experience: Two (2) years of directly related work experience preferred. Experience in processing physician office and/or hospital referrals Proficient in Computer usage