Referral Coordinator

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Regular - Hourly Full-Time Clerical Winter Haven, FL, US

3 days ago Requisition

The Referral Coordinator is responsible for ensuring that authorizations and referrals are properly obtained prior to the patients arriving for their appointment. The coordinator is also responsible for processing any authorizations and referrals on behalf of the patient to another specialist provider.

• High school diploma or GED required
• Bachelor or Associate Degree preferred
• One year experience in an Ophthalmic setting required
• Experience in Ophthalmic insurance verification preferred

• Ability to problem solve
• Detail-oriented
• Understanding of Medicare, Medicaid, and other commercial insurance
• Comprehensive knowledge of Medicare, Medicaid, HMO, and Commercial Insurance plans and eligibility requirements
• Familiar with ICD-9/10 and CPT Coding for Ophthalmology
• Excellent communication skills, proper grammar, and writing capability
• Team-oriented
• Self-directed, highly motivated, and able to multi-task in a fast-paced environment
• Capable of handling multiple projects accurately and efficiently
• Exceptional interpersonal skills
• Caring, patient, and friendly attitude
• Familiarity with all forms (paper & electronic) associated with the patient’s medical record
• Understanding of ophthalmic terms and spelling
• General knowledge of ophthalmic diseases

• Retrieves the appointment list of patients by running appropriate reports five to seven days before the visit and review each account.
• Verify whether we have a referral or authorization already on file or if a new request needs to be created.
• Creating a referral or authorization request using the CPT Procedure code fax form and sending it with all appropriate patient chart notes for approval to the primary care physician.
• Keeping a running log of what has been requested from the primary care physicians and following up on the requests if the referral or authorizations have not been received.
• Communicates with the primary care physicians or other specialists' providers in a pleasant and expeditious manner for any referral or authorization requests and/or troubleshooting
• Properly documents authorization details in the patient’s “alert” section of the medical record
• Correct any demographic or insurance information that is not accurate
• Input any demographics, referrals, authorizations, or patient information into the practice management software.
• Obtains insurance referrals or authorization for emergency walk-in patients
• Scan referrals or authorizations into the patients' demographics in the practice management software
• Professional and Personal Development/Goals and Objectives
• Exhibits professional demeanor with a positive, enthusiastic attitude at all times when representing the practice
• Must attend all in-services and webinar training seminars as directed by the Manager
• Sets goals and objectives for professional growth. Reviews and revises goals on an ongoing basis
• Provides input on how to improve customer service, decrease costs and increase revenues for the practice
• Customer Service
• Supports the practice core values and mission statement to develop, enhance, and promote quality customer service through team effort
• Exhibits flexibility, sensitivity, and respect while maintaining an effective working relationship with all team members
• Maintains practice confidentiality, follows HIPAA & OSHA guidelines, and follows the rules and regulations of the practice as documented in the practice employee manual
• Maintains proper standards of productivity as defined by management
• Completes any additional tasks and responsibilities as noted in the pay for performance program
• Assumes other duties as assigned

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential function of this job

• The majority of the time on the job is spent walking, sitting for long periods, reaching with hands and arms,…