Referral coordinator is responsible for preparation and processing referrals according to health plan benefits and appropriate contracted provider. The referral coordinator identifies health plan and CMS documents needed to assist next level of review. The position would also involve going online or calling for benefits, Health Plan policies or criteria for referrals received via EHR or via fax. Essential duties include providing excellent customer service/patient services via phone. The position must exemplify the core values and mission Doctors Medical Center (DMC) the core values and mission of the organization, always exercising utmost discretion, diplomacy and tact in patient/staff interactions. Reports directly to Referral Manager.
DUTIES AND RESPONSIBILITIES:
- Maintain ongoing tracking and appropriate documentation on referrals
- Ensure complete and accurate patient demographic and current insurance information
- Assist patient with scheduling appointments
- Review details and expectations about referrals with patients
- Establish and maintain relationships with identified service providers
- Responsible for scheduling consultations, diagnostic testing and surgical procedures
- Responsible to schedule and notify patients of scheduled appointment via mail and phone
- Ensure that referrals are addressed in a timely manner
- Responsible for verifying eligibility and benefits through insurance companies including obtaining prior authorization
- Protects patient confidentiality, making sure protected health information is secured by not leaving PHI in plain sight and logging off the computer before leaving it unattended
- Answer phone calls referral related and offer assistance to ensure 1st call resolution
- Works as a liaison in between medical center and patient and sends tasks accordingly
- Responsible to notify referral manager of any issues or concerns from patient and/or provider
- Follow up on patient referral inquires not immediately resolved
- Assists as needed or directed with other department or business needs
Planning and organizing, communication skills, attention to detail, adaptability, customer service orientation, problem solving, decision-making, confidentiality, integrity, stress tolerance.
EDUCATION AND EXPERIENCE:
- High school diploma or graduation equivalency degree (GED)
- 2-5 years of relevant experience with managed care referral preferred
- Bilingual English/Spanish/Creole strongly preferred
- Excellent time management and organizational skills
- Knowledge of applicable regulations and state and federal laws
- Computer skills including knowledge of relevant software
- Ability to multitask in a fast pace environment
The person should be multi-functional and have the ability to multi-task; the person should have strong communication skills; must have strong organizational skills; must have strong customer service and conflict resolution skills; must have strong trouble shooting skills; must have knowledge of insurance and medical terminology. Must possess strong computer skills.
Note: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, knowledge, and skills required for this position. Doctor’s Medical Center is an equal employment opportunity employer. Employment offer subject to qualifications, references, and background check.
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