Referral Coordinator

About the role

The Referral Coordinator is responsible for obtaining and coordinating insurance authorizations and pre-certifications for services provided across all assigned OBGYN divisions, providers, and locations.

Location: US-VA-Norfolk

Responsibilities

• Reviewing schedules and patient information to identify authorization requirements
• Verifying insurance eligibility and benefits
• Submitting authorization requests
• Monitoring requests through completion
• Documenting authorization numbers, dates, and determinations accurately in the medical record
• Working closely with providers, clinical staff, scheduling, and billing teams to resolve authorization issues, prevent delays in patient care, and ensure compliance with payer requirements and organizational policies
• Review patient schedules and obtain required prior authorizations, retro-authorizations, and Global Care Fee authorizations for EVMS Full Care patients
• Obtain authorizations for obstetrical hospital-based procedures and services, as well as other OBGYN, Maternal Fetal Medicine, diagnostic, and treatment services as deemed necessary by the department
• Obtain required authorizations and referrals from referring physician offices
• Verify patient insurance eligibility and identify applicable authorization and referral requirements
• Monitor authorization requests and follow up as necessary to obtain timely approvals or resolve authorization issues
• Communicate with patients regarding insurance related requirements, self-pay agreements, and applicable co-payments as appropriate
• Document authorization approvals and denials, including approved CPT codes and authorization numbers, in the EHR
• Complete assigned EHR tasks in accordance with Medical Group standards and departmental requirements
• Receive and complete assigned tasks from providers and staff in a timely and accurate manner
• Scan and upload required documents into the appropriate patient charts on a daily basis
• Maintain accurate, complete, and timely documentation related to authorizations, referrals, insurance verification, and patient accounts
• Communicate relevant authorization and insurance information to providers, staff, and other appropriate departments to support continuity of patient care and efficient workflow
• Maintain compliance with policies and procedures of the Department of Obstetrics and Gynecology as well as applicable EVMS Medical Group policies and procedures
• Collaborate with providers, staff, referring physician offices, patients, and other departments to support efficient departmental operations
• Perform other duties as assigned in accordance with individual departmental needs and operational priorities

Minimum Qualifications and Skills

• Ability to balance multiple priorities and tasks required
• Professional interaction skills with physicians, outside offices, insurance companies, referring agencies, hospital personnel and support staff required
• Excellent verbal and written communication skills required
• Ability to read and comprehend all information required for this position required

Preferred Qualifications

• Minimum of two‑years’ experience as Medical Receptionist, Patient Account Representative or other relevant role directly handling Medical Insurance information is strongly preferred