Referral/Prior Authorization Coordinator

Qualifications

Computer Skills

CNA/CMA/MOA

Job Description
Referral Coordinator
Job Summary: Performs a wide range of administrative clinical duties to include referral processing; insurance authorizations; referral patient appointment scheduling; communication with providers and clinical staff; communication with referral sources and other tasks as assigned.

Essential Functions

Responsible for initiating diagnostic and routine referrals.

Responsible for tracking, coordinating, and communicating patient referrals to providers, clinical staff, and patient(s).

Responsible for communicating any delays in referral scheduling to provider.

Ensures complete and accurate patient referral information, including demographics and current insurance information, is communicated to referral sources.

Serves as point person in the referral evaluation process to include patient scheduling, and internal communications.

Serves as point person for third party communications, including prior authorizations.

Assembles referral information concerning patient’s clinical background and referral needs.

Contacts insurance companies to ensure verification of benefits and prior authorization approval requirements are met.

Reviews details and expectation(s) of referral with the patient.

Assists patient to problem solve potential issues related to financial or social barriers, ie. interpreters, transportation, etc.

Ensures that referrals are addressed in a timely manner per Goshen Medical Center’s policy.

Communication with referral source to ensure patient referral is complete.

Communicates with referral source(s) to complete the patient’s referral process by assuring patient attended scheduled appointment and that EMR contains notes from appointment.

Skills and Qualifications

Strong patient focus with two (2) years of medical experience.

Effective verbal and written communication skills.

Strong working knowledge of medical terminology.

Organized and able to manage multiple priorities.

Able to take and follow through with delegated tasks and accountability.

Electronic medical record experience, preferred.

High school diploma or general education degree and two (2) years of related experience.

Physical Demands

Frequently use hands to finger, handle, or feel and talk or hear.

Occasionally required to stand, walk, sit, and reach with hands and arms.

Occasionally lift and/or move up to 10 pounds.

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