Referral Coordinator

Job Summary

Affirms that services approved by private payors have been completed and requests additional visits for patients throughout their episode of care. Manages referrals and works closely with team members to ensure optimal utilization and cost containment. Provides clerical support and assistance to staff.

Details of the Position

• Oversees data entry and completion of referral forms/notifications.
• Obtains insurance pre-authorization for patients and reauthorizes additional treatment.
• Ensures insurance carrier (including Medicare) documentation requirements are met and referral support documentation is filed in patient's medical record.
• Efficiently manages correspondence with patients, physicians, specialists, insurance companies.
• Demonstrates knowledge of standardized guidelines as recommended by evidence-based medicine.
• Communicates with billing staff and third-party payors to assure coverage of patient care.

Qualifications

• Accredited School Preferred
• Business or two years college Preferred
• Medical Assistant, Licensed Practical nurse, or Registered Nurse Minimum of 3 years Required
• Experience working in insurance in a medical related field, or other related experience Preferred
• National Certified Medical Assistant or Preferred
• Licensed Practical Nurse - Oregon or Preferred
• Registered Nurse Preferred

Skills

• Demonstrated experience in insurance requirements for referrals and/or prior authorizations to various therapies (PT, RT, OT, ST), surgeries, procedures, diagnostic testing, and infusions.
• Proficient with MS Office applications.
• Proficient with Horizon Home Care.

Working Conditions

• Consistently operates computer and other office equipment.
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
• Sedentary work.
• Predominantly operates in an office environment.
• Ability to communicate and exchange accurate information.
• Close visual acuity to perform activities such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

Benefits

Competitive and comprehensive total rewards package includes full medical/dental/vision coverage, 403b retirement plan employer base and matching contributions, paid time off, employer-paid life and disability insurance with additional buyup coverage options, tuition and continuing education reimbursement, wellness benefits, expanded EAP and mental health program.