Referral and Insurance Coordinator

Position Summary

The Referral Authorization Coordinator is responsible for coordinating specialty care for patients in need of external consultation as requested by the primary care physician. The Referral Coordinator will also be responsible for scheduling, tracking, referral case management and providing reports. The Referral Coordinator will represent the company professionally and positively to enhance and promote the core values and mission, always exercising utmost discretion, diplomacy and tact in customer interactions.

Major Duties and Responsibilities

• Ensure complete and accurate patient demographics and current insurance information.
• Processes patient referrals to specialty providers by preparing medical charts and records for referral patient visits and providing appropriate clinical information to specialist.
• Obtain authorizations for patient referrals to specialists, diagnostic testing and procedures. Advise physician if authorization request is denied.
• Maintains Insurance authorization for each patient and establishes patients benefits eligibility (not limited to copay, coinsurance, deductible, out of pocket, etc.)
• Maintains patient charts by Chart Prepping daily.
• Maintain ongoing tracking and appropriate documentation on referrals by recording all referrals into EHR.
• Ensure that referrals are addressed in a timely manner, prioritizing urgent items appropriately.
• Other duties as assigned.

Knowledge, Skills and Abilities

• Knowledge of current Microsoft Office Suites including Word, Excel, Outlook, PowerPoint, Access. Office 2007 or newer required.
• Knowledge of appropriate medical terminology
• Skill in providing excellent customer service.
• Skill in verbal and written communication.
• Ability to work scheduled hours as defined in the job offer.
• Ability to modify own working style, approach, or methodology to fit new/changing circumstances.
• Ability to read and understand oral and written instructions and follow written protocols.

Education / Training / Requirements

• Associates degree or equivalent.
• At least 1 year of relevant experience.

Physical Demands

• Ability to stand and walk for long periods of time.
• Ability to sit for extended periods of time.
• Ability to climb or balance for limited periods of time.
• Ability to occasionally reach, bend, stoop and lift up to 30 lbs. *
• Ability to grasp and hold up to 25 lbs.*
• Ability to hear normal voice level communications in person or through the telephone.
• Ability to speak clearly and understandably.
• Ability to taste and smell.

Success Factors

• Alignment with Company Mission and Core Values
• Excellent Time Management/Organized
• Open Communication/Positive
• Goal Driven
• Excellent Customer Service
• Juggles Multiple Priorities
• Accuracy and Attention to Detail
• Accomplished in word processing and worksheet utilization

All statements are essential functions of the position unless identified as non-essential by an asterisk (*).