Referral Coordinator

Responsibilities

• Coordinates and monitors daily work flow processes and activities for meeting required referral insurance deadlines within 72 hours or as directed by provider - e.g., Stat emergent.
• Daily reviews and monitors referral work queue in order to provide accurate and timely referral process documentation.
• Serves as the first-line resource for all customers internal and external with regards to Insurance and Referrals. Must be knowledgeable in all areas of insurance verification and authorization referral processes.
• Maintain accurate and current referral log on all patients.
• Serve as liaison for patient with doctor offices with regards to processing referrals. Communication may be via fax, telephone, electronically.
• Review and analyze managed care patient visits and ensure proper documentation of required services.
• Coverage internal functions and recordkeeping related to managed care organizations to meet compliance.
• In collaboration with staff in LG Patient Financial Services, ascertain physician credentialing is current and required documentation on file.
• Organizes in-service programs for staff regarding all referral insurance process changes and updates.
• Liaison between patient and insurance company to explain to patient what their insurance company requires to meet referral authorization compliance.
• Maintains knowledge of registration and scheduling processes with the capability of filling in as needed based on office workload or staffing demands.
• As needed, assist Billing Coordinator with assigned tasks.
• Provide educational sessions to resident physicians and staff.
• Identifies any system dysfunction or discrepancies and reports to Supervisor Manager, making recommendations for improving current department and hospital-wide procedures.
• Afford other projects or responsibilities as required by Supervisor Manager.
• Addresses gaps in care in an attempt to help patients reconcile any remaining health care screenings or surveillances.
• May outreach to patients who expresses a desire for a new LGHP PCP to schedule an appointment.

Qualifications

• High school diploma or certificate
• One year of computer experience
• One year clerical or clinical experience in a medical practice setting
• One year experience in medical referral insurance
• One year of using medical terminology
• Basic keyboarding ability and telephone interpersonal etiquette is required
• Successful completion of customer service training module or commensurate experience with successful completion of related competency testing is also required
• Attention to detail - The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others
• New learning and memory - The following level of ability is essential for the jobholder to learn and retain material
• Problem solving, reasoning and creative thinking - The following level of ability that is essential for the jobholder to think in order to solve a problem by combining two or more elements from past experience or imaginative thought
• Communication - Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information
• Interpersonal relations - Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others