Referral Coordinator

JOB SUMMARY

Responsible for scheduling referrals for patients, providers, pre-authorizing and pre-certifying tests/procedures. Reviews clinical data to report medical necessity to insurance companies. Directly communicates with the clinics, referred to clinics and patients. Arranges for efficient and orderly admission of inpatients and admission of individuals who have hospital-based outpatient testing or procedures. Performs all work in accordance to the mission, vision and values of the practice.

Responsible for scheduling referrals for patients, providers, pre-authorizing and pre-certifying tests/procedures. Reviews clinical data to report medical necessity to insurance companies. Directly communicates with the clinics, referred to clinics and patients. Arranges for efficient and orderly admission of inpatients and admission of individuals who have hospital-based outpatient testing or procedures. Performs all work in accordance to the mission, vision and values of the practice.

• Responsible for knowing hospital policies and being familiar with hospital services that are available.
• Demonstrates an ability to be flexible, organized and function well in stressful situations.
• Treats patients and their families with respect and dignity; ensures confidentiality of patients’ records.
• Interacts professionally with patient/family and provides explanations and verbal reassurance as necessary.
• Maintains good working relationships both within the department and with other departments.
• Ensures that documentation meets current standards and policies.
• Answers the telephone in a polite manner and communicates information to the appropriate personnel/family member.
• Obtain prior authorization for testing, procedures and surgeries.
• Detailing reasons for denial and possible appeal measures.
• Track referral submissions.
• Maintain spreadsheets detailing medical procedures and insurance denials and approvals.
• Verify insurance benefits and eligibility before referring clients.
• Performs other related duties as assigned by the clinic coordinator/supervisor.

• Basic computer knowledge.
• Ability to type accurately with speed.
• Able to use office machines efficiently.
• Excellent customer service skills.

• High school or GED (Required)
• Prefers someone who has at least 6 months experience in a medical office or hospital setting.

• Ability to effectively communicate both verbally and written
• Bi-lingual (Spanish) preferred

• Must be able to life 40 lbs.
• Must be able to stoop, bend or sit for long periods of time.