Referral Coordinator (CC3809 - Metro Specialty)

Responsible for

• answering telephones
• scheduling appointments
• providing exemplary customer service

Responsibilities

• Processes referrals for Adult Medicine, Pediatric, Medical Specialty and Behavioral Health providers
• Verifies insurance coverage and obtains authorization for treatment according to third party payer guidelines
• Documents referral/authorization information and communication in Electronic Health Record (EHR) system
• Schedules patient appointments utilizing established provider templates
• Ensures patient demographics and insurance information in the EHR is complete, accurate and up to date
• Works cohesively and interdepartmentally with providers and support staff to optimize templates; performs patient schedule changes as needed
• Documents and relays information with external providers as appropriate to facilitate patient care
• Demonstrates appropriate telephone etiquette according to the policies and procedures of the department, and provides prompt and courteous service upon each telephone call received
• Proactively participates in the implementation of new initiatives and processes
• Suggests improvements in call flow processes and communication as needed; participates in organized efforts to continuously improve service excellence levels
• Fulfills Center’s policies and procedures pertaining to patient privacy and protected health information
• Reports any potential breach of privacy, HIPAA violation or suspicious behavior or activity relating to patient health records to supervisor or other appropriate chain of command
• Processes referrals according to the oldest date ordered and level of urgency, tracks and manages referrals throughout every stage to avoid backlog and ensure completion, and maintains consistent channel of communication between staff, providers and patients
• Coordinates between patient, PCP and specialty provider for appointment scheduling; informs provider and/or supervisor of unusual delay, insurance issue or other problem with completing referral in a timely manner
• Notifies patient of reasoning for incomplete processing and provides feedback for referral via messaging system or telephone call; provides additional instructions as needed
• Provides excellent internal/external customer service via telephone, messaging system and fax contact to assist patients with their healthcare needs
• Performs other related duties as assigned

Qualifications

• High School graduate or equivalent required
• Medical Referral Experience Preferred
• Minimum of one year of experience in customer service, preferably in a healthcare setting
• Experience With EMR/EHR And Medical Terminology Preferred
• Excellent oral and written communication and interpersonal skills
• Experience With Insurance Verification And Healthcare Billing Preferred
• Proficient in the use of personal computers, including Microsoft Word, Excel and Outlook
• Bilingual in English and Spanish preferred