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Referral Coordinator

3 months ago

Carrollton, United States Tanner Health System Full time

Centralized Referral Coordinator duties: Working with the Greenway Referral Module, this position schedules testing, procedures, and referrals for TMG practices. Obtains prior authorizations for procedures, outpatient tests, and referrals. Position works closely with the practices and maintains strict confidentiality.

**Education**
High School Diploma or GED

**Experience**
Two years of related experience. Requires working knowledge of specialized practices, equipment, and procedures.

**Licenses & Certifications**
- NONE REQUIRED

**Qualifications**
- 2 years of related experience in a clinical environment. Experience in clinical, referral, or coding area.
- Ability to organize, analyze, and prioritize work.
- Basic knowledge of medical terminology and anatomy required.
- Data entry experience preferred. Business like appearance. Detail oriented. Ability to multi-task. Ability to work closely with others and function as a team member.
- Exhibit exceptional communication and negotiating skills to interact with payers, providers, and patients.
- Must possess the initiative and drive to take a project from beginning to a successful completion.
- Working knowledge of CPT and ICD-9 coding required.

Requirements**:Area of Responsibilities**
- Communicates financial responsibility to the patient for referral, procedures, or consultation. Maintains communication with the patients and informs them of any and all patient responsibilities prior to the scheduled appointments. Maintains knowledge of insurance copays, deductibles, and other types of payer plans.
- Customer Service: Provides customer service functions to include addressing patient, hospital, and provider inquiries, and complaints from all sources in a timely manner. Initiates necessary corrections to patient complaints and attempts to repair damage done to relationship with patient. This will require interaction with co-workers, physician offices, hospital, insurance carriers, and Administration. Success indicated by problems being resolved by team member requiring little director intervention. Participates in patient satisfaction initiatives. Demonstrates excellent customer service skills. Communicates effectively with patients and management regarding service recovery opportunities. Works together with other team members to achieve Office and System customer service goals
- Referral Coordinator duties: Working with the Greenway Referral Module and scheduling all specialists consults for TMG Primary Care Practices. Obtains patient records and demographic information to provide to specialists when making referrals. Position works closely with the practices and maintains strict confidentiality. Has routine meetings with providers and practice staff to address issues, concerns, and other areas of functionality to improve performance.
- Teamwork: Works well with others and functions as a team player. Offers ideas and solutions for issues that affect the team and work area. Participates in the training and skills development of new front office employees. Assists in other areas of the office as necessary.
- Utilizes insurance portals to obtain prior authorizations for HMO coverage plans.
- Assists with special projects as needed.
- Development: Maintains a current knowledge of clinical operations, including medical knowledge. This will be required to understand referrals requested by providers. Develops and maintains a working knowledge of CPT and ICD coding. Participates in continuing education. Participates in the development of new programs.
- Ensure that providers are notified using the Greenway EMR when a procedure, consultation, or result is complete, and documentation is available for review by sending notification to the provider.
- Prepares productivity reports each month, including but not limited to calls, referrals, and amounts collected. Referral reporting is generated monthly and provided to Administration.

**Compliance Statement**
Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, the Compliance Officer, or the Hotline.

**Education**
High School Diploma or GED

**Experience**
Two years of related experience. Requires working knowledge of specialized practices, equipment, and procedures.

**Licenses & Certifications**
- NONE REQUIRED

**Qualifications**
- 2 years of related experience in a clinical environment. Experience in clinical, referral, or coding area.
- Ability to organize, analyze, and prioritize work.
- Basic knowledge of medical terminology and anatomy required.
- Data entry experience preferred. Business like appearance. Detail oriented. Ability to multi-task. Ability to work closely with others and function as a team member.
- Exhibit exceptional communication and negotiating skills to interact with payers, providers, and patients.
- Must possess the initiative and drive to take