Referral Coordinator

Trinity Health

2d•Onsite

About The Position

This position is responsible for all aspects of the referral process, including authorizations and follow-up. The Referral Coordinator acts as a liaison among providers, patients, and health plan administrators. They are responsible for reviewing and submitting clinical information to health plan case managers for special referral pre-certification and out-of-plan or out-of-network referrals, monitoring authorizations or denials and following up as necessary. The role involves communicating referral status to patients and physicians, ensuring referrals are processed accurately and in a timely manner. This includes answering incoming calls related to referrals, outreach to patients for appointment and insurance information, and verifying insurance through payor sites. The Referral Coordinator tracks referrals until fulfilled, which includes outbound calls to patients and external specialists for updates, and may involve requesting external specialist office visit notes. They update the patient medical record (EMR) with approval of declination of information and follow up with the primary care physician regarding referral authorization status or issues. Communication with the ordering provider, practice support staff, and insurance company representatives is also a key function. The role participates in data collection of insurance companies, supports other offices, attends required meetings and training, and participates in committees as requested. Additionally, the Referral Coordinator assists with special projects and assumes additional duties as assigned.

Requirements

High School Diploma
Minimum 2 years’ experience with insurance referrals, prior authorization or other relevant medical office experience.
Knowledge of medical terminology and procedures at the level needed to perform responsibilities.
Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations.
Proficient knowledge of major health plans and insurance processes.
Excellent written (legible), verbal and face-to-face communication skills, including ability to effectively explain relevant insurance information to patients, as well as communicate with insurance plans and internal customers.
Proper phone etiquette.
Proficient/knowledgeable in patient care procedures and organizational policies related to position responsibilities.
Service-oriented; responsive to customer needs and courteous in approach.
Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, EPIC, Microsoft Word /Excel/Outlook, intranet and computer navigation.
Ability to use other software as required while performing the essential functions of the job.
Ability to compute mathematical calculations.
Ability to work independently and collaboratively in a team-oriented environment; displays professional and friendly demeanor.
Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, vendors, outside customers and couriers.
Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
Good organizational and time management skills to effectively juggle multiple priorities and time constraints.
Ability to exercise sound judgement and problem-solving skills.
Ability to handle patient and organizational information in a confidential manner.
Ability to travel to other office/practice sites and meeting and training locations.
Successful completion of IHA competency-based program within introductory and training period.
Physical activity that often requires keyboarding, filing and phone work.
Physical activity that often requires extensive time working on a computer.
Physical activity that sometimes requires walking, standing, bending, stooping, reaching, and/or twisting.
Physical activity that sometimes requires lifting, pushing and/or pulling under 30 lbs.
Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus.
Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

Nice To Haves

None

Responsibilities

Contacts insurance companies via appropriate methods and obtains authorizations if applicable for specific plans.
Educates patients and staff with pertinent referral and insurance information.
Obtains urgent authorizations same day and next day, if needed.
Assists patients in scheduling appointments with specialists and helps resolve referral issues.
Generates referral information for physicians, patients, and health plans.
Acts as a liaison among providers, patients, and health plan administrators.
Reviews and submits clinical information to health plan case managers for special referral pre-certification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up, as necessary.
Communicates referral status to patients and physicians; ensures that referrals have been processed accurately and in a timely manner to coincide with patient treatment plan.
Answers incoming calls that are relevant to referrals.
Outreaches to patients when appropriate for details on appointments and/or insurance information.
Verifies insurance through payor sites and notifies patients if there needs to be changes made prior to processing the referral.
Tracks referrals until fulfilled by the patient, including outbound calls to patients and external specialists for updates.
Requests external specialist office visit notes to be shared with the referring provider.
Updates information in the patient medical record (EMR) with approval of declination of information; follows up with the primary care physician as to the status and/or issues with the referral authorization.
Communicates with the ordering provider for next steps with practice support staff and representatives of insurance companies.
Participates in data collection of insurance companies.
Supports other offices, attends required meetings and training, and participates in committees, as requested.
Assists with special projects and assumes additional duties as assigned.