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; monitors authorizations or denials and follows up, as necessary. The role also involves communicating referral status to patients and physicians, ensuring that referrals have been processed accurately and in a timely manner to coincide with patient treatment plans. This includes answering incoming calls relevant to referrals, outreach to patients for appointment and/or insurance information, and verification of insurance. The Referral Coordinator tracks referrals until fulfilled by the patient, which includes outbound calls to patients and external specialists for updates. They may also need to request external specialist office visit notes to be shared with the referring provider and update the patient medical record (EMR) with approval of declination of information, following up with the primary care physician regarding the status and/or issues with the referral authorization. Communication with the ordering provider for next steps with practice support staff and representatives of insurance companies is also a key responsibility. Additionally, the role involves participation in data collection of insurance companies, supporting other offices, attending required meetings and training, participating in committees, and assisting with special projects and 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.

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.

Benefits

• Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED