Monday - Friday
SUMMARY
The person in the position of the Referral Coordinator must be able to perform the duties described within as well as to meet the company’s qualifications. The referral coordinator must have exceptional communication skills to communicate effectively with clinic managers and referring providers. Individuals must be organized, and be able to manage a demanding workload with accuracy.
ESSENTIAL DUTIES AND RESPONSIBILITIES
specific to the authorization department include the following:
- Responsible for the completion of all incoming/outgoing referrals as assigned.
- Maintain ongoing tracking and appropriate documentation on the status of referrals. Referrals should be addressed in timely manner, by reviewing and reconciling overdue and/or pending orders in the work queue.
- Referrals should be addressed in timely manner, by reviewing and reconciling overdue and/or pending orders in the work queue. Escalate routine referral delays more than 14 business days.
- Assemble information concerning patient’s clinical background and referral needs.
- Knowledge and understanding of ICD-10 and CPT Codes
- Contact insurance companies to ensure all prior authorization needs are met. Present necessary medical information such as history, diagnosis and prognosis.
- Be the system navigator and point of contact for patients with outstanding referrals, assuring patient is aware of referral by reviewing details and expectations.
- Contact external offices to ensure referral is received, to obtain patient appointment date, including all relating information.
- Ensure the patient’s chart is up to date with demographics, insurance information, and information on specialist consults; scanning appropriate follow-up documents into system.
- Scans all patient visit documentation into EHR
- Covers various front office positions as needed
- Other duties as assigned
QUALIFICATIONS
For the employee to execute this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
The employee performing this position is expected to hold a High school diploma or general education degree (“GED”); and at least three months (preferably six months) related experience (e.g., health care setting, customer service, etc.) and/or training; or equivalent combination of education and experience. The employee performing this position is expected to have some experience with medical terminology and understanding of medical insurance process. S/he must be able to understand or quickly learn about the differences between and among patients with private insurance, Medicare, Workers’ Compensation and self-paying patients, etc.
PREFERRED
Bilingual may be required during certain shifts.
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
CONDITION OF EMPLOYMENT:
Proof of identity and legal authority to work in the U.S. is a condition of employment. Cypress Healthcare Partners/Salinas Valley Health Clinics will not sponsor applicants for work visas.
The range displayed on this job posting reflects the target for new hire salaries for this position.
Skills Required
- High school diploma or GED
- At least three months (preferably six months) related experience in healthcare, customer service, or equivalent training
- Experience with medical terminology and understanding of medical insurance processes (private insurance, Medicare, Workers' Compensation, self-pay)
- Knowledge and understanding of ICD-10 and CPT codes
- Ability to scan patient visit documentation and maintain/update records in an EHR
- Ability to contact insurance companies for prior authorizations and present necessary medical information
- Strong communication skills and ability to manage a demanding workload accurately
- Proof of identity and legal authority to work in the U.S. (employer will not sponsor work visas)
- Bilingual (may be required during certain shifts)
What We Do
Montage Health is a nonprofit healthcare organization with deep roots in Monterey County dating back more than 90 years. Independent and locally owned, Montage Health was created by Community Hospital of the Monterey Peninsula to deliver exceptional care to more people. Centered at the hospital, the Montage Health network includes MoGo Urgent Care, Montage Orthopedics and Sports Medicine Center, Montage Wellness Center, Montage Medical Group for primary and specialty care, Aspire Health Plan, and Ohana, a family-focused youth mental health program. Montage Health is continually investing in healthcare innovations to make the highest standard of care accessible to everyone in Monterey County.
