Referrals Coordinator

Jersey Community Hospital•Jerseyville, IL

About The Position

The Referrals Coordinator is responsible for patient prior authorizations and referrals, including scheduling internal referrals and outgoing patient referrals. The role documents the status of authorizations and referrals, navigates registration, referral entries, and authorization/certification entries, updates and confirms current patient insurance coverage, and monitors prior authorization and referral work queues on a day-to-day basis. The coordinator communicates with patients and insurance companies about coverage and related matters, discusses benefits with patients, and responds to patient and third-party inquiries. Responsibilities also include insurance verification and precertification according to payer requirements, identifying outpatient procedures requiring precertification or a second opinion, obtaining required information from physicians, and precertifying inpatient admissions. The role conducts physician-office and patient interviews, explains hospital procedure guidelines and policies, provides preparation and appointment instructions, and follows procedures for special requirements, STAT requests, and schedule modifications while coordinating with clinical areas. The coordinator notifies patients about physician orders, preauthorization, and other financial-clearance requirements, and performs other duties as assigned.

Requirements

High school graduate or equivalent.
Excellent communication and interpersonal skills to discuss financial matters with patients or their representatives and work with professionals at JCH and other organizations.
Ability to comprehend complex information and explain insurance benefits to patients or their representatives.
Ability to respond to quickly changing priorities and patient needs.
Motor coordination and finger dexterity to operate computer equipment and other office machines.

Nice To Haves

Prior medical experience and knowledge of insurance policies and procedures.
Knowledge of medical terminology.
Demonstrated computer skills and related experience.

Responsibilities

Process patient prior authorizations and referrals, including scheduling internal and outgoing referrals.
Document the status of prior authorizations and referrals.
Navigate registration, referral entries, and authorization/certification entries.
Update and confirm current patient insurance coverage and monitor authorization and referral work queues daily.
Communicate with patients and insurance companies regarding coverage and related matters; discuss benefits and respond to patient and third-party inquiries.
Complete insurance verification and precertification according to payer requirements.
Identify outpatient procedures requiring precertification or a second opinion and obtain required information from physicians.
Precertify inpatient admissions.
Conduct physician-office and patient interviews and explain hospital procedure guidelines and policies.
Provide patients with preparation and appointment instructions.
Follow procedures for special requirements, STAT requests, and schedule modifications, coordinating with clinical areas to accommodate patient requests.
Notify patients of physician orders, preauthorization, and other financial-clearance requirements.
Perform other roles and responsibilities as assigned.