JOB SUMMARY:

The Referral Coordinator is responsible for initiating and completing internal/external referral requests and providing initial review of benefits and eligibility for services requiring authorization.

ESSENTIAL FUNCTIONS:

• Responsible for initiating and completing internal/external, pre-certification referral requests
• Reviews patient eligibility and benefits
• Assigns appropriate diagnosis and procedure codes following coding guidelines for all referral requests
• Aids primary care practitioners and office staff with coding and target review questions
• Maintains current knowledge of both coding and targeted review items to ensure that requests are initiated and sent correctly per benefit guidelines and adheres to time frame specified by ELH standards
• Ensure coding is completed correctly on all requests to meet all regulatory guidelines and audit standards which will result in compliance and correct reimbursement
• Assists and educates patients by answering questions regarding referral and authorization process
• Maintains effective communication with physicians and staff as necessary to gather information for referrals as needed
• Provides verbal notification in accordance to policy and procedure for patients and providers with respect to the outcome of their requested service
• Maintains excellent customer service and professionalism with providers, patients and team members
• Any other duties and/or special projects as assigned

QUALIFICATIONS REQUIRED:

• High School graduate or equivalent required
• Minimum of 1 year experience in the same or similar role
• Insurance company/managed care procedural experience preferred
• Previous experience with eClinical Works electronic medical records software preferred

We offer our employees a comprehensive benefits package that includes:

• Medical insurance with prescription drug coverage
• Dental insurance
• Vision insurance
• Company-paid child care
• Company-paid basic life insurance
• 401(k) with company match
• Dependent Care Flexible Spending Account
• Healthcare Flexible Spending Account
• Paid time off

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