Referral Coordinator
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Job Description
Referral Coordinator coordinating insurance authorizations, appointments, and documentation. Supporting patient access to specialty services at CommUnityCare community health centers.
Responsibilities:
- Monitor templates for appointment availability
- Orient and train new referral department team members under the direction of the Triage and Referral Nurse Manager
- Schedule appointments according to clinic guidelines
- Audit referral team records as needed
- Gather insurance and financial information to determine patient financial responsibility
- Obtain referral authorizations for specialty services and communicate authorizations or denials to patients and providers
- Resolve pre-authorization, registration, and other referral-related issues before appointments
- Contact patients verbally or in writing according to protocol
- Maintain updated referral resources
- Complete and uphold referrals through the full referral process
- Follow referral Standard Operating Procedures
- Address PCP referral requests in a timely manner
- Complete documentation in EPIC and keep patient records current and complete
- Attend team huddles, scheduled meetings, and seminars
- Participate in quality strategies and evaluate compliance with evidence-based guidelines
- Ensure patient-care and administrative tasks comply with regulatory, accreditation, Joint Commission, and organizational standards
- Develop favorable relationships with clinical managers, support staff, providers, business office staff, patients, and families
- Collaborate with the care team to provide patient-centered care
- Perform other duties as assigned
Requirements:
- High School Diploma or equivalent
- Three years’ experience in the healthcare field, including one year experience as a Medical Assistant, Medical Administrative Clerk, Patient Services Representative, or Dental Assistant
- Ability to utilize computers for data entry and information retrieval
- Excellent verbal and written communication skills
- Knowledge of federal, state, and local insurance regulations
- Knowledge of the referral process for a variety of insurance plans
- Success in researching and resolving complex issues
- Familiarity with electronic devices and GUIs common in healthcare environments, including spreadsheets, word processing, patient record systems, and EHR systems
- Ability to meet defined productivity standards
- Maintain required licensure and/or certification requirements for continuing education and best practices
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