Referral Coordinator

Duties & Responsibilities

• Maintains the electronic health record to receive and process requests for referrals and diagnostic imaging prior authorizations during standard clinical hours.
• Prioritizes and processes referrals and related forms from multiple providers.
• Reviews new referrals and diagnostic imaging prior-authorization requests for completeness and accuracy.
• Interprets standard insurance guidelines to identify incomplete referrals before processing and communicates directly with the care team regarding necessary testing or records.
• Fulfills the role of a liaison between insurance companies and care teams for high-risk referrals and diagnostic imaging requests.
• Accesses insurance companies' web-based program(s) to check the status of pending prior authorizations.
• Escalates unresolved high-risk referral issues back to the care team in a timely manner.

Qualifications

• Excellent oral and written communication skills, able to effectively communicate medical and behavioral health conditions to community specialists.
• Ability to work independently and as part of a healthcare team.
• Basic knowledge/experience in navigating web-based portals and using Microsoft Office products such as Excel, Word, and Outlook.
• Attention to detail required.
• Medical terminology required.
• Proficiency in using the PCHC electronic health record and scheduling system, preferred.
• Ability to develop positive relationships with community specialists and insurance carriers.
• Experience with processing prior authorizations and referrals, preferred.
• Knowledge of state and federal health care programs, including Medicaid, Medicare, and other public benefits programs, preferred.
• Knowledge of HIPAA regulations and ability to maintain strict confidentiality of patient health information at all times.
• Experience working with the under-served and uninsured populations.
• Access to reliable transportation.
• Background check/Life Links access required.
• Ability to communicate with people of various diverse backgrounds in a sensitive and compassionate way.

Education

• Minimum of an Associate’s Degree and/or completion of a medical training program.
• Prior experience working in an ambulatory care center, preferred.