Referral Coordinator

The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.

Other information:

Job Summary
Coordinate referral and authorization duties for medical care. Communicate with patients, participants and team members to accurately schedule patients for prescribed referral. Help patients navigate through referrals, insurance authorizations, scheduling appointments, and answering questions as appropriate. Responsible for providing customer service to patients in person or by telephone. Works effectively and cooperatively within the workplace. Location/Department specific tasks and competencies may apply. The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job. Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.

Essential Functions
Monitor and manage referral work queues. Confirms insurance coverage via payer portals and determines necessity for pre-authorization. Verify and document insurance eligibility. Complete referral authorization processes in a timely manner. Facilitate the resolution of insurance issues. Coordinate insurance authorization and referral requirements. Ensure all requirements are fulfilled in accordance with established guidelines. Track and submit retro-authorization requests, working closely with referring physician offices to resolve issues. Sort fax server in an accurate and timely manner in accordance with established guidelines. Obtains authorization and processes referrals for services ordered by providers. Schedules appointments as appropriate and within required time and assuring referrals are maintained within appropriate network and/or payer requirement. Remains current on referral policies and procedures, payer requirements, managed care matrix, and portals. Maintain ability to effectively utilize Microsoft Office (Outlook) and department specific software applications to perform work. Communicate effectively and cooperatively in the workplace. Actively contribute to the achievement of Quality Improvement and Lean Process Improvement activities. Complete all mandatory learning requirements in a timely manner. Attend and actively participate in all department, team and/or committee meetings. Comply with all Skagit Regional Health, department and location specific policies and procedures. Perform other duties as assigned by Supervisor or designee. Maintain availability to float to other departments as needed.

Education
High School graduate or GED required.

Experience/Training
Minimum one (1) year healthcare referral experience preferred. Minimum one (1) year healthcare experience preferred. Prior knowledge of electronic medical records, medical terminology preferred. Proven excellent customer services skills required.

License/Certifications
None required.

Other Skills
Effective verbal, written and interpersonal communication skills required. Must be able to effectively utilize Microsoft Office applications to perform work. Well-developed problem solving and analytical skills required. Must be able to effectively prioritize workload amongst frequent interruptions with competing priorities. Proven ability to grasp new programs and concepts quickly.

Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time; when working in office or remote setting. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position in an office/cubicle or remote setting. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment onsite at the office with remote work possibilities. This position is remote-hybrid eligible. Must be able to work independently with little supervision in a home environment with privacy.Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.