Referral Coordinator

Essential Job Functions

• Contacts insurance companies via appropriate methods and obtains authorizations if applicable for specific plans.
• Educates patients and staff with pertinent referral and insurance information.
• Obtains urgent authorizations same day and next day, if needed.
• Aids patients in scheduling appointments with specialist and helps resolve referral issues.
• Generates referral information for physicians, patients and health plans.
• Acts as a liaison among providers, patients and health plan administrators.
• Reviews and submits clinical information to health plan case managers for special referral pre-certification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up, as necessary.
• Communicates referral status to patients and physicians; ensures that referrals have been processed accurately and in a timely manner to coincide with patient treatment plan.
• Answers incoming calls that are relevant to referrals.
• Outreach to patients when appropriate for details on appointments and/or insurance information.
• Verifies insurance through payor sites and notifies patients if there needs to be changes made prior to processing the referral.
• Test tracks the referrals until fulfilled by the patient. This includes outbound calls to patients and external specialists for updates. At times, may need to request external specialist office visit notes to be shared with the referring provider.
• Updates information in the patient medical record (EMR) with approval of declination of information; follows up with the primary care physician as to the status and/or issues with the referral authorization.
• Communicates with the ordering provider for next steps with practice support staff and representatives of insurance companies.
• Supports other offices, attends required meetings and training, and participates in committees, as requested.
• Assists with special projects and assumes additional duties as assigned.

Organizational Expectations

• Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of Trinity Health Medical Group.
• Works effectively as a member of the Referral Coordinator team.
• Works safely to assure personal safety and that of coworkers, and reports all preventable hazards and unsafe practices immediately to management.
• Completes all relevant organizational training and adheres to Trinity Health Medical Group standard of care as outlined in the Trinity Health Code of Conduct.
• Maintains knowledge of and complies with Trinity Health Medical Group standards, policies and procedures.
• Maintains general knowledge of Trinity Health Medical Group office services and in the use of all relevant office equipment, computer and manual systems.
• Maintains strict confidentiality in compliance with Trinity Health Medical Group and HIPAA guidelines.
• Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities.
• Embraces new ideas and respects cultural differences.
• Uses resources efficiently.

Essential Qualifications

• EDUCATION: High School Diploma
• CREDENTIALS/LICENSURE: None
• MINIMUM EXPERIENCE: Minimum 2 years’ experience with insurance referrals, prior authorization or other relevant medical office experience.

Position Requirements (abilities & Skills)

• Knowledge of medical terminology and procedures at the level needed to perform responsibilities.
• Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations.
• Proficient knowledge of major health plans and insurance processes.
• Excellent written (legible), verbal and face-to-face communication skills, including ability to effectively explain relevant insurance information to patients, as well as communicate with insurance plans and internal customers. Proper phone etiquette.
• Proficient/knowledgeable in patient care procedures and organizational policies related to position responsibilities.
• Service-oriented; responsive to customer needs and courteous in approach.
• Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, EPIC, Microsoft Word /Excel/Outlook, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job.
• Ability to compute mathematical calculations.
• Ability to work independently and collaboratively in a team-oriented environment; displays professional and friendly demeanor.
• Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, vendors, outside customers and couriers.
• Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
• Good organizational and time management skills to effectively juggle multiple priorities and time constraints.
• Ability to exercise sound judgement and problem-solving skills.
• Ability to handle patient and organizational information in a confidential manner.
• Ability to travel to other office/practice sites and meeting and training locations.
• Successful completion of IHA competency-based program within introductory and training period.