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Referral Coordinator

Under the supervision of the Directors of Patient Services and the Referral Supervisor, the Referral Coordinator is responsible for the processing of insurance referrals, professional communication with both internal and external clients, the registration and documentation of patients at check in as needed, and the provision of excellent customer service. 

Please submit your application HERE!

Representative Duties:

1. Accurately set up referrals for all patients and send to specialists in a timely manner

  • Respond to requests regarding authorization for services
  • Consult with PCPs to make decisions when specialists are unavailable
  • Prepare authorizations using insurance company websites or calls to managed care companies
  • Obtain, distribute and document referral authorization numbers
  • Input referral numbers into CPS and monitor cancellations, expirations, and changes to referrals
  • Track services provided to managed care patients off-hours and in emergency
  • Schedule radiology and specialist appointments when instructed by a PCP

2. Educate patients, providers, and staff on the various managed care programs 

  • Educate patients toward proactive use of managed care companies and referral authorization process
  • Inform providers and /or patients of plan changes

3. Monitor and update managed care member listings and verify membership eligibility 

  • Explain updates to coworkers and replace obsolete information
  • Update specialty provider offices regarding changing insurance company requirements
  • Meet with insurance company representatives to learn updates or pertinent referral information

4. Research problems related to billing services for primary care

  • Proactively process referrals for specialists working at FH sites
  • Assist patients and patient services staff in calling insurance companies to change PCPs to FH or obtain referrals from outside providers to FH PCPs Inform patients that they will face a financial obligation if they fail to change their PCP with their insurance company to a FH provider, or obtain a referral to FH

5. Referral tracking

  • Assign referral a tracking modifier
  • Request clinical notes from specialist office after patient’s visit
  • Obtain clinical notes via fax and Care web
  • Locate the tracking referral and complete the referral process        

6. Accurately performs registration process for new and existing patients

  • Accurately register new patient demographic data in CPS
  • Obtain patient insurance data, completed and signed documentation (IIF), and copy of insurance card entering information into CPS accurately
  • Ask each patient at check in to verify existing demographic information and insurance information, accurately record and enter any changes received
  • Collect co-payments and agreed fees at check-in  Accurately record the payment and issue a receipt to the patient
  • Be encouraging and sensitive in informing all uninsured or underinsured patients that a meeting with the Financial Assistance Advisor is available to them

7. Schedules appointments according to established procedures

  • Schedules appointments according to the patient’s needs and provider availability
  • Schedule the appointment within each patient’s Primary Care team  If there is no availability, refer to the team nurse for instruction on how to facilitate the patient
  • Call patients one day prior to their scheduled appointment to remind them of the date, time and provider they will be seeing
  • Thank patients for choosing FH and let them know that we look forward to seeing them

8. Adheres to Patent Registration policies and procedures

 

9.Accurately balance grids and cash drawers

 

10. Participates in quality assessment and improvement activities as requested

 

11. Provide excellent customer service 

 

12. Meet agency participatory expectations

 

13. Perform other related duties as requested

Requirements

  • Minimum of high school graduate or equivalent, BA/BS preferred
  • Familiarity with state and commercial insurance
  • Knowledge of US healthcare delivery and managed care requirements preferred
  • Computer experience required, especially with electronic medical record software, billing/registration software, and Microsoft Office
  • Able to meet deadlines, follow through on assigned tasks, and attend carefully to details
  • Able to proactively reach out to team members to offer or receive help, ask or answer questions
  • Successful customer service background required; bilingual Spanish/English preferred
  • Willingness to work with a diverse patient population including the LGBTQIA+ community, seniors, students, and others 
  • Calm, patient, and understanding manner
  • A willingness to accept changes and challenges
  • Ability to work harmoniously with diverse groups of individuals
  • Experience working in an ethnically, culturally, and racially diverse environment preferred

Ability to meet the following physical requirements with or without reasonable accommodations:

  • Sit at a computer station for extended periods of time
  • Ability to type on a keyboard for extended periods of time
LGBTQ-identified persons, people of color, and others from historically underrepresented communities are encouraged to apply.