Referral Coordinator Reviewer

Palm Medical Centers•Coral Gables, FL

8d•Onsite

About The Position

The Referral Coordinator Reviewer is responsible for reviewing medical referrals to determine medical necessity and ensure compliance with CMS (Centers for Medicare & Medicaid Services) guidelines and criteria. This role involves thorough evaluation of referral documentation, application of clinical guidelines, and collaboration with healthcare providers to facilitate appropriate patient care.

Requirements

Minimum of 2 years of experience in a clinical or healthcare setting.
Strong understanding of CMS guidelines and criteria.
Excellent analytical and critical thinking skills.
Effective communication and interpersonal skills.
Proficiency in using healthcare information systems and software.
Strong medical knowledge and clinical background.
Ability to work independently and as part of a team.

Nice To Haves

Foreign Medical graduate (preferred)
Prior experience managing referrals (preferred)

Responsibilities

Review and assess medical referrals to establish medical necessity based on CMS guidelines and other guidelines.
Apply clinical guidelines and criteria to ensure referrals meet established standards.
Communicate with healthcare providers to obtain additional information or clarification as needed.
Document review findings and decisions accurately in the appropriate systems.
Collaborate with other healthcare team members to ensure coordinated and efficient patient care.
Maintain up-to-date knowledge of CMS guidelines and criteria.
Participate in quality improvement initiatives and training sessions.
Ensure compliance with all regulatory and organizational policies and procedures.