Referral Coordinator

Job Description

Job Description

Title: Referral Coordinator

Department: Customer Care

Status: Hourly

Location: Customer Care Office

Reports To: Customer Care Supervisor

Direct Reports: None

Summary of Position: Under the direct supervision of the Customer Care Supervisor, this position is responsible in obtaining information, insurance verification and authorization required for proper patient treatment and referrals in a timely and accurate manner.

Minimum Qualifications: The following qualifications are the minimum necessary to adequately perform this job. However, any equivalent combination of experience, education, and training which provides the necessary knowledge, skills, and abilities would be acceptable, subject to any legal and/or regulatory requirements. Bilingual (English/Spanish) preferred.

Education: High School Diploma or GED certificate required; two years related experience and/or training; equivalent combination of education and experience.

Experience

• Basic skills using MS Excel and MS Word.
• Ability to handle a high volume of patient flow with comfort and confidence.
• Knowledge of ICD-9 and CPT codes for the purpose of authorizations.
• Knowledge of insurance plans and their rules.

Certification(s)/Licensure: None

Key Responsibilities:

1. Must be able to sit, stand and walk for long periods of time
2. Ability to read and understand the English language
3. Ability to effectively maintain confidentiality of records and communicate with all levels of personnel
4. Receive, track and obtain insurance authorization from in-network and out-of-network insurance carriers for referred patient and Follow-Up visits with Specialty care providers.
5. Process physician referral orders (EMG, CT, MRI, etc.) using Allscripts (EMR system). This includes obtaining any insurance authorization needed.
6. Coordinate new therapy referrals for insurance plans that require authorization (AHCCCS, work comp, etc). This includes obtaining any insurance authorization needed.
7. Accurately enter notes into Allscripts (EMR system) regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications. These documents should also be scanned into the appropriate patients chart in Allscripts (EMR system).
8. Remain updated with therapy & radiology location insurance contracts.
9. Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
10. Documents all interactions on an account with a Note.
11. Ability to write simple correspondence.
12. Ability to effectively present information in one-on-one and small group situations to patients, clients, and other employees of the organization.
13. Ability to apply common sense understanding to carry out detailed written or oral instructions.

Kintegra Health Core Requirements:

1. Patient First – An approach to care that holds primary, the well-being and desires of the patient

2. Build not Blame – Focusing first on finding fault with the process rather than the person

3. Integrity and Honesty – Fostering an acceptance of openness, honesty, and fairness in words, deeds and the use of organizational resources judiciously for both internal and external customers

4. Cooperation and Flexibility – Related to an internal believe that we function as part of an interdependent team with only shared gains or losses thereby committed to assisting whenever possible beyond the prerequisite job description

5. Culturally Sensitive – Always working toward increasing one’s ability to understand, communicate with, effectively interact and care for people across cultures, while having an acute awareness of one’s own culture.