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Referral/authorization Coordinator

4 months ago

Lakeland, United States Dedicated Senior Medical Centers Full time

The Care Coordinator (Referrals Coordinator) is a highly visible customer service and patient-focused role that works directly with our patient population and their families, insurance representatives and outside vendors, physicians, clinicians and other medical personnel in a dynamic and professional environment to provide the highest level of quality healthcare to our members.

**ESSENTIAL DUTIES AND RESPONSIBILITIES**:

- Coordinates and processes patient referrals to completion with precision, detail and accuracy.

**Definition of completion**:

- Prioritizes HPP patients in Primary Care Physicians panel, stats, expedites and orders over 5 days.
- Orders have been approved (when needed).
- Schedules patient (Preferred Providers List of Specialist) and notifies them of appointment information, including, date, time, location, etc.
- Uses Web IVR to generate authorizations (Availity, Careplus, Healthhelp NIA and any other approved web IVR for authorization processing).
- Completes orders with proper documentation on where patient is scheduled and how patient was notified.
- Referrals have been sent to specialist office & confirmed receipt.
- Prepares and actively participates during physician/clinician daily huddles utilizing RITS Huddle Portal and huddle guide. Communicates effectively the physicians/clinicians needs or outstanding items regarding to patients.
- Enters all Inpatient and Outpatient elective procedures in HITS tool.
- Ensures patient's external missed appointment are rescheduled and communicated to the physician/clinician.
- Participates in Super Huddle and provides updates on high priority patients referrals.
- Addresses referral based phone calls for Primary Care Physicians panel.
- Completes and addresses phone messages within 24 hours of call.
- Retrieves consultation notes from the consult tracking tool.
- Follows up on all Home Health and DME orders to ensure patient receives services ordered.
- Provide extraordinary customer service to all internal and external customers (including patients and other
- ChenMed Medical team members) at all times. Utilization of patient messaging tools.
- Performs other related duties as assigned.

**KNOWLEDGE, SKILLS AND ABILITIES**:

- Must be detail-oriented, possess the ability to multi-task and be open to cross-functionally training in referrals duties.
- The individual in this role must exercise proper phone etiquette and have the ability to navigate proficiently through computer software systems.
- Must be team-oriented and work extremely well with patients, colleagues, physicians and other personnel in a professional and courteous manner.
- Exceptional organizational skills with the ability to effectively prioritize and timely complete tasks. Knowledge of medical terminology, CPT, HCPCS and ICD coding preferred.

**EDUCATION AND EXPERIENCE CRITERIA**:

- High School diploma or equivalent required.
- Up to one (1) year of relevant work experience required. Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred. Healthcare experience in a clinical setting, preferably within the Medicare HMO population is a plus.
- CPR for Healthcare Providers is preferred. A valid driver's license in State of employment is required; position may require travel within the market.

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance

Weekly day range:

- Monday to Friday
- No weekends

Application Question(s):

- Do you have experience with Availity?

**Education**:

- High school or equivalent (preferred)

**Experience**:

- Medical Office: 2 years (preferred)
- Referral Coordinator: 2 years (preferred)
- Web IVR's: 1 year (preferred)
- Authorizations: 2 years (preferred)

Work Location: In person