Referral Center Representative

Responsibilities

• Works on patient referrals by coordinating appointment scheduling and ensuring the timely and accurate processing of referral requests, initiating referrals within 24 hours on business days, and documenting all stages in Electronic Medical Records (EMR) systems.
• Captures and documents insurance pre-authorizations and approvals from Third-Party Payers (TPP) for services as required.
• Tracks and monitors referrals, ensuring proper documentation and follow-ups for injury cases, and maintains accurate referral reports for management.
• Acts as a liaison between patients, providers, employers, insurance companies, attorneys, and healthcare facilities to ensure seamless communication, care coordination, and timely notification of appointments and procedure instructions.
• Maintains current knowledge of payer-specific prior authorization requirements, attending virtual workshops and reviewing updates from insurance providers.
• Serves as a point of contact for patients, providers, and other stakeholders, ensuring clear communication and coordination of care.
• Monitors and distributes incoming faxes, voicemails, and messages, forwarding them to appropriate personnel as required.
• Completes necessary forms and requisitions for referrals and diagnostic testing, ensuring accurate Current Procedural Terminology (CPT) / International Classification of Diseases, 10th Revision (ICD-10) coding for billing and insurance purposes.
• Maintains current knowledge of payer-specific prior authorization requirements, attending virtual workshops and reviewing updates from insurance providers.
• Supports quality improvement initiatives by tracking referral trends, identifying delays, and implementing workflow optimizations.
• Ensures adherence to the Health Insurance Portability and Accountability Act (HIPAA) regulations, maintaining patient confidentiality while handling sensitive information.

Qualifications

• Education: High School Diploma or equivalent required.
• Licenses/Certifications: IA/IL Child Abuse Mandatory Reporter Training in state(s) where providing care required within 90 days of hire. IA/IL Dependent Abuse Mandatory Reporter Training in state(s) where providing care required within 90 days of hire.