Referral Coordinator

36412 Navicent Health Medical Center
- Pulmonology Clinic

Full time

Yes

40

Monday
- Friday 8 AM - 5 PM

$21.85 - $32.80

• Coordination of the Referral Process
  • 1)
    Collects all referrals from medical staff daily and obtains any necessary approvals from attendings.
  • 2)
    Works in all aspects of the referral process, including processing referrals for patients based on primary care physician orders and follow up specialists service recommended.
  • 3)
    Generates necessary correspondence or calls to patients, physicians and office staff, managed care organizations or vendors requesting additional information and requirements for referral authorization.
  • 4)
    Communicates with appropriate Physician, nursing staff and patients regarding follow-up status of referrals.
  • 5)
    Prepare correspondence, input referral information in the automated system, collects additional medical necessity supporting documentation and provide to appropriate parties for approval.
  • 6)
    Attend PHO and other vendor meetings as required to discuss changes in processing requirements.
  • 7)
    Identifies potential problems (i.e., labs, x-rays, procedures, and other physicians) with payment of charges from referral by communication with PHO and other managed care specialists.
• Reviews all payor requirements by type of service and organizes materials to ensure appropriate referral and that steps are followed to avoid claims denials.
  • 1)
    Investigates diagnosis codes and medical necessity guidelines to determine if appropriate based on payor guidelines.
  • 2)
    Discusses any discrepancies with physician for correct coding of referral.
  • 3)
    Provide correct codes both ICD9 and CPT and explains coverage to ordering physician.
  • 4)
    Input codes into automated system and discuss any certification requirements with vendor’s nurse certification specialist.
  • 5)
    Monitors approval status and resubmit request as necessary.
  • 6)
    Identifies need for appeal process with insurance companies and Medicare and initiates process.
• Participate in education and eligibility problem resolution.
  • 1)
    Works with attendings and nurses in the education of physician office staff on referral procedures.
  • 2)
    Acts as a resource to customers and help resolve referrals, claims and eligibility issues.
  • 3)
    Communication with manager, program director, other health care professionals, and various staff in a positive fashion in order to promote patient satisfaction, quality services delivered and resolution of issues.
  • 4)
    Verify eligibility of patients including problem resolution with Advocate MSO and various managed care organizations.
  • 5)
    Identifies and maintains appropriate communication with supervisor involving problems and observations in course of daily operations.
  • 6)
    Other duties as needed.
• Establish controls and a tickler system set-up to see if services are obtained. Maintain tracker to ensure:
  • 1)
    Patient received the services ordered before termination of the referral.
  • 2)
    Patient have proper paperwork before going to the referral site.
  • 3)
    Results are received from the specialist prior to the patient’s next appointment.
  • 4)
    Respond as needed to same day request from patient, if patient urgently needed to see a specialist or forgot paperwork.
• Assures that referral documentation is filed in the medical record and physician sees clinical results of the referrals based on a tracking system put in place.
  • 1)
    Collect all faxed or mailed in consultant reports for referred patients.
  • 2)
    Sort and place in physician mail boxes for review with patient chart.
  • 3)
    Assure that physician has signed off acknowledging review.
  • 4)
    File data in patient chart and re-file the record in the medical records file room.

• H.S. diploma or…