Referral Coordinator - Ambulatory Clinic - Full Time

36412 Navicent Health Medical Center - Pulmonology Clinic
Full time
Monday - Friday 8 AM - 5 PM
Coordination of the Referral Process

• 1)Collects all referrals from medical staff daily and obtains any necessary approvals from attendings.
• 2)Works in all aspects of the referral process, including processing referrals for patients based on primary care physician orders and follow up specialists service recommended.
• 3)Generates necessary correspondence or calls to patients, physicians and office staff, managed care organizations or vendors requesting additional information and requirements for referral authorization.
• 5)Prepare correspondence, input referral information in the automated system, collects additional medical necessity supporting documentation and provide to appropriate parties for approval.
• labs, x-rays, procedures, and other physicians) with payment of charges from referral by communication with PHO and other managed care specialists.
• Reviews all payor requirements by type of service and organizes materials to ensure appropriate referral and that steps are followed to avoid claims denials.
• 1)Investigates diagnosis codes and medical necessity guidelines to determine if appropriate based on payor guidelines.
• 2)Discusses any discrepancies with physician for correct coding of referral.
• 1)Works with attendings and nurses in the education of physician office staff on referral procedures.
• 2)Acts as a resource to customers and help resolve referrals, claims and eligibility issues.
• 3)Communication with manager, program director, other health care professionals, and various staff in a positive fashion in order to promote patient satisfaction, quality services delivered and resolution of issues.
• 4)Verify eligibility of patients including problem resolution with Advocate MSO and various managed care organizations.
• 5)Identifies and maintains appropriate communication with supervisor involving problems and observations in course of daily operations.
• 1)Patient received the services ordered before termination of the referral.
• 2)Patient have proper paperwork before going to the referral site.
• Assures that referral documentation is filed in the medical record and physician sees clinical results of the referrals based on a tracking system put in place.
• 4)File data in patient chart and re-file the record in the medical records file room.

3-4 years experience in a managed care organization, hospital or physician’s office with 1 year referral experience

• Excellent medical terminology comprehension and its effective usage
• Completion of 1 Medical Terminology class with certificate of completion.

Computer literate
~Experience with IDX, Windows and other I.S. Flexible with job responsibilities

If position has direct patient care or direct patient contact the following lifting requirement supersedes any previous lifting requirement effective 06/01/2015. Ability to lift up to 35 pounds without assistance. For patient lifts of over 35 pounds, or when patient is unable to assist with the lift, patient handling equipment is expected to be used, with at least one other associate, when available. Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Opportunity for annual increases based on performance
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
full-time, part-time, per diem, temporary, etc.); Providing care under the names Advocate Health Care in Illinois; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
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