Referral Coordinator

Advocate Health and Hospitals Corporation•Elkin, NC

16h•Onsite

About The Position

This full-time position is responsible for the coordination of the referral process within the WFBMG Hugh Chatham department. The Referral Coordinator will manage referrals from medical staff, process them according to physician orders and specialist recommendations, and communicate with patients, physicians, and managed care organizations to ensure proper authorization and information flow. This role involves generating correspondence, inputting data into automated systems, collecting supporting documentation, and attending vendor meetings to stay updated on processing requirements. The coordinator will also identify and resolve potential payment issues, investigate diagnosis codes and medical necessity guidelines, and assist in the appeal process when necessary. Additionally, the role includes educating physician office staff on referral procedures, acting as a resource for referral and eligibility issues, and maintaining communication with supervisors regarding daily operations. A key aspect of the role is establishing controls and a tickler system to track services, ensure proper paperwork, and confirm results are received from specialists. The coordinator will also manage the filing of referral documentation and consultant reports in the medical record.

Requirements

H.S. diploma or G.E.D.
3-4 years experience in a managed care organization, hospital or physician’s office with 1 year referral experience
Excellent medical terminology comprehension and its effective usage
Completion of 1 Medical Terminology class with certificate of completion.
Excellent communications skills.
Computer literate
35 wpm keyboarding preferred
Experience with IDX, Windows and other I.S. systems
Good organizing skills.
Good problem-solving skills
Ability to handle difficult calls and maintain professional conduct
Excels as a team player
Flexible with job responsibilities
Ability to work independently.
Ability to handle stress and high workload volumes.
Ability to communicate denial of services to members and providers.
Ability to lift up to 35 pounds without assistance.

Responsibilities

Collects all referrals from medical staff daily and obtains any necessary approvals from attendings.
Works in all aspects of the referral process, including processing referrals for patients based on primary care physician orders and follow up specialists service recommended.
Generates necessary correspondence or calls to patients, physicians and office staff, managed care organizations or vendors requesting additional information and requirements for referral authorization.
Communicates with appropriate Physician, nursing staff and patients regarding follow-up status of referrals.
Prepare correspondence, input referral information in the automated system, collects additional medical necessity supporting documentation and provide to appropriate parties for approval.
Attend PHO and other vendor meetings as required to discuss changes in processing requirements.
Identifies potential problems (i.e., labs, x-rays, procedures, and other physicians) with payment of charges from referral by communication with PHO and other managed care specialists.
Reviews all payor requirements by type of service and organizes materials to ensure appropriate referral and that steps are followed to avoid claims denials.
Investigates diagnosis codes and medical necessity guidelines to determine if appropriate based on payor guidelines.
Discusses any discrepancies with physician for correct coding of referral.
Provide correct codes both ICD9 and CPT and explains coverage to ordering physician.
Input codes into automated system and discuss any certification requirements with vendor’s nurse certification specialist.
Monitors approval status and resubmit request as necessary.
Identifies need for appeal process with insurance companies and Medicare and initiates process.
Works with attendings and nurses in the education of physician office staff on referral procedures.
Acts as a resource to customers and help resolve referrals, claims and eligibility issues.
Communication with manager, program director, other health care professionals, and various staff in a positive fashion in order to promote patient satisfaction, quality services delivered and resolution of issues.
Verify eligibility of patients including problem resolution with Advocate MSO and various managed care organizations.
Identifies and maintains appropriate communication with supervisor involving problems and observations in course of daily operations.
Other duties as needed.
Establish controls and a tickler system set-up to see if services are obtained.
Maintain tracker to ensure: Patient received the services ordered before termination of the referral.
Patient have proper paperwork before going to the referral site.
Results are received from the specialist prior to the patient’s next appointment.
Respond as needed to same day request from patient, if patient urgently needed to see a specialist or forgot paperwork.
Assures that referral documentation is filed in the medical record and physician sees clinical results of the referrals based on a tracking system put in place.
Collect all faxed or mailed in consultant reports for referred patients.
Sort and place in physician mail boxes for review with patient chart.
Assure that physician has signed off acknowledging review.
File data in patient chart and re-file the record in the medical records file room.

Benefits

Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program