Referrals Coordinator

Jersey Community Hospital•Jerseyville, IL

1d•$16 - $21

About The Position

Responsible for patient prior authorization and referrals, including scheduling internal referrals and outgoing patient referrals. The role documents the status of prior 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 daily. 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. The role verifies insurance and completes precertification according to payer requirements, including identifying outpatient procedures requiring precertification or a second opinion, obtaining required information from physicians, and precertifying inpatient admissions. The position conducts interviews with physician offices and patients, explains hospital procedure guidelines and policies, and provides patients with preparation and appointment instructions. It follows guidelines for special requirements, STAT requests, and schedule modifications, coordinating with clinical areas to accommodate patient requests. The coordinator notifies patients of physician orders, preauthorization, and other financial clearance requirements, and performs other assigned responsibilities.

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.
Work is of light physical demand; motor coordination and finger dexterity are required 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

Complete patient prior authorizations and schedule 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 about coverage and related matters.
Discuss benefits with patients and respond to patient and third-party inquiries.
Verify insurance and complete precertification according to payer requirements.
Identify outpatient procedures requiring precertification or a second opinion, obtain required information from physicians, and 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 responsibilities as assigned.