Job Summary:

The Referral Coordinator is responsible for processing internal, incoming, and external referrals for Ambulatory services, procedures, and medications. The position will obtain prior authorizations, schedule patients, work inbound and outbound phone calls, and communicate with patients via online chat.

Major Responsibilities / Duties / Critical Tasks:

• Ensures current and standardized referral policies and workflows are followed and utilized on a regular basis.

• Prioritizes referrals by their urgency and addresses them in a timely manner.

• Participates and successfully completes required orientation and training related to job responsibilities.

• Ensures complete demographic, insurance information, and appropriate/pertaining clinical information is sent to referred specialists.

• Contacts insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis, and prognosis to insurance companies if deemed necessary to prove the medical necessity of services.

• Reviews details and expectations about the referral with ordering providers and patients. Requests new referrals to be ordered when applicable.

• Identifies and utilizes community resources; establishes relationships with servicing providers and personnel.

• Serves as point of contact for patients and specialists for any questions or concerns. Assist in problem-solving potential issues related to their referral due to language or social barriers. If unable to help, assist in finding the right point of contact to further help.

• Receives requests for prior authorization through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored.

• Processes referrals and submit medical records to insurance carriers to expedite prior authorization processes.

• Manages correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.

• Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.

• Reviews the accuracy and completeness of the information requested and ensure that all supporting documents are present.

• Meets departmental goals for referral authorization processing, scheduling, and phone responsibilities.

• Meets individual productivity and accuracy requirements as determined by the Supervisor and/or Manager.

• Cooperates and interacts with supervisors, peers, other departments, and all customer groups demonstrating commitment to service.

• Other duties as assigned.

Accompanying Knowledge, Skills, Abilities and Competencies:

• Excellent written and verbal communication skills.

• Ability to organize information.

• Ability to handle sensitive information with absolute confidentiality.

• Proficiency in Microsoft Office programs (Outlook, Word, Excel, PowerPoint).

Required Education / Experience:

• High school graduation or equivalent.

• Associates degree or Bachelor’s Degree is preferred.

• Minimum of 2 years’ experience in administrative work in a clinical setting.

• May consider a combination of education and experience.