Referral Coordinator

Referral Coordinator is responsible for processing all incoming referrals by various methods including external physicians and APPs, insurance payers, online presence, etc. Responsibilities include obtaining, validating, and tracking of referrals/prior authorizations/reauthorizations with requirements that vary based on patient insurance plans.

• Communicate, build relationships, and liaise between PCPs, other specialists, and patients in referral approval process
• Perform chart prep audits to identify and work missing referrals/authorization prior to patient appointments (timing is critical)
• Incoming/Outgoing phone calls to patients, other medical practices, and medical insurance companies
• Work daily batch files, print, scan, and route documents and carefully verify in patient’s electronic chart
• Complete authorization requests via phone, online portal, fax, etc.
• Ensure documentation requirements are met for both insurance carrier and patient medical record
• Verify patient eligibility & benefits via online hub, portal, or live calls
• Understand medical insurance and benefit details to assist with patient education
• Communicate effectively with internal teams and serve as a resource for physician liaisons, physicians/APPs and clinic staff, patients, and other third parties as it relates to referrals and authorizations
• Schedule patient appointments in multiple system platforms
• Priorize tasks with moderate supervision (work STAT requests urgently and accurate)
• Ability to understand related metrics and create process improvements that align with goals

Qualifications and Experience:

• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
• Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.

Typical Physical Demands

Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds. Position requires prolonged sitting, some bending, stooping, and stretching. Good hand-eye coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.