Referral Coordinator

2 weeks ago

Lumberton, United States Southeastern Integrated Care LLC Full time
Job DescriptionJob Description

Summary:

The Referral Coordinator will be responsible for managing and coordinating patient referrals to specialists or other healthcare providers. This role requires excellent communication skills, strong attention to detail, and the ability to collaborate with patients, healthcare professionals, and insurance companies. Performs a wide range of administrative duties to include referral processing, patient registration, verification of benefits, insurance authorizations, patient appointment scheduling, program communication to potential candidates, communication with referral sources. Ensures excellent customer service and supports the mission and vision of our Advance Medical Home Primary Care facility.

Essential Duties and Responsibilities:

  • Coordinate and manage all aspects of the referral process for patients in the advanced medical home primary care office.
  • Ensures that referrals are addressed in a timely manner
  • Reminds patients of scheduled appointment
  • Communication with referral sources to ensure patient information/ registration is complete
  • Communicates patient updates between program and referring source
  • Review patient medical records and gather necessary information to initiate the referral process.
  • Contacts insurance companies to ensure verification of benefits and prior authorization approval requirements are met. Verify insurance coverage and obtain necessary authorizations for referrals.
  • Ensure all required referral paperwork and documentation are completed accurately and in a timely manner.
  • Communicate with patients to explain the referral process, answer questions, and address concerns
  • Collaborate with healthcare providers and specialists to facilitate the referral process and ensure seamless care coordination.
  • Responsible for the tracking, coordination, and communication of patient referrals
  • Ensures complete and accurate patient registration, including demographics and current insurance information
  • Manages requests from third party referral sources and provides relevant information and data
  • Serves as point person for multidisciplinary evaluation process to include patient scheduling, third party communications, and internal communications
  • Assembles information concerning patient’s clinical background and referral needs
  • Reviews details and expectation of referral with the potential patient
  • Assists patients in problem solving potential issues related to financial or social barriers (e.g., request interpreter as appropriate, transportation services, etc.)
  • Maintain accurate and up-to-date records of referral activities and ensure proper documentation.
  • Follow up with patients to ensure they have received the necessary care and address any issues or concerns.
  • Uploading documentation into Athena via scans and Prior Authorizations for imaging referrals
  • Communicate with insurance companies to track the progress of referrals and resolve any billing or authorization issues.
  • Stay updated on insurance requirements, referral guidelines, and healthcare policies to ensure compliance.
  • Other duties as assigned

    Education and Training Requirements:
  • High school diploma or equivalent; associate or bachelor's degree in healthcare administration or related field is preferred.
  • Proven experience as a referral coordinator or in a similar role within a healthcare setting.
  • Knowledge of medical terminology, insurance procedures, and referral guidelines.
  • Strong organizational skills and attention to detail.
  • Excellent communication and people skills to effectively interact with patients, healthcare professionals, and insurance companies.
  • Ability to work independently and as part of a team in a fast-paced environment.
  • Proficiency in using electronic medical record (EMR) systems and other relevant software.
  • Understanding of HIPAA regulations and patient confidentiality.

Supervisory Responsibilities:

None

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The work is typically performed in an office environment, with a moderate noise level.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Movements including but not limited to prolonged periods of sitting at a desk and working on a computer, occasional standing, walking, bending, and reaching are required.
  • Regularly required to use hands to manage or feel; talk; see; and/or hear. Specific vision abilities required by this job include close vision and color vision.
  • Must be able to lift up to fifteen pounds at all times.

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