Referral Coordinator/Fulle Time/Days

About the role

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Schedule

40 hours/week, Monday–Friday. Onsite position. No weekends or holidays.

Responsibilities

• Plans, organizes, directs and coordinates all aspects of the referral office.
• Coordinates and monitors daily workflow processes and activities to meet required referral insurance deadlines within 72 hours or as directed by provider (e.g., stat emergent).
• Reviews and monitors referral work queue to provide accurate and timely referral process documentation.
• Serves as the first-line resource for all internal and external customers regarding insurance and referrals; knowledgeable in all areas of insurance verification and authorization referral processes.
• Maintains accurate and current referral log on all patients.
• Serves as liaison between patients and doctor offices regarding processing referrals; communication may be via fax, telephone, or electronically.
• Reviews and analyzes managed care patient visits and ensures proper documentation of required services.
• Coordinates internal functions and recordkeeping related to managed care organizations to meet compliance.
• In collaboration with staff in LG Patient Financial Services, ascertains physician credentialing is current and required documentation is on file.
• Organizes in-service programs for staff regarding all referral insurance process changes and updates.
• Liaises between patient and insurance company to explain what the insurance company requires to meet referral authorization compliance.
• Communicates in a positive, customer-service manner when using department tools (telephone, fax, email, voicemail, etc.).
• Exhibits teamwork and excellent customer service skills for both internal and external customers.
• Collaborates with internal/external LG staff, other physician offices, and outside agencies to resolve patient questions and complaints regarding referral insurance issues.
• Maintains knowledge of registration and scheduling processes with the capability of filling in as needed based on office workload or staffing demands.
• Assists Billing Coordinator with assigned tasks as needed.
• Provides educational sessions to resident physicians and staff.
• Identifies system dysfunction or discrepancies and reports to Supervisor/Manager, making recommendations for improving current department and hospital-wide procedures.
• Assists with 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 express a desire for a new LGHP PCP to schedule an appointment.
• Outreaches to patients who have not been seen within the prior 18 months at their LGHP PCP office and schedules patients accordingly to maintain their LGHP relationship.

Requirements

• 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.
• Successful completion of customer service training module or commensurate experience with successful completion of related competency testing.

Abilities

• Attention concentration: Ability to attend to more than one aspect of a situation simultaneously; multiple task demands required at the same time.
• New learning and memory: Ability to learn new tasks quickly and effectively; understand and carry out detailed, involved instructions that change frequently.
• Problem solving, reasoning and creative thinking: Issues or problems often require thoughtful reasoning before arriving at approaches or solutions; some independent thought, planning or origination of options and solutions is necessary.
• Leadership, control and planning: Ability to accept responsibility for leadership, direction, control, planning, negotiating, organizing, directing, supervising, formulating practices, or making final decisions.
• Repetitive work: Ability to continuously perform the same type of work for extended periods of time, according to set procedures, sequence or pace.
• Performing under stressful conditions: Ability to perform under stress when confronted with emergency, critical, unusual, or dangerous situations, or in situations in which working speed and sustained attention are critical aspects of the job.
• Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure, involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.
• 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 to others.