Referral Coordination Specialist

2 weeks ago


San Antonio, Texas, United States Christus Health Full time

Position Overview:

The role of the Referral Coordination Specialist involves managing the comprehensive referral workflow within a medical practice comprising 35 physicians. This includes acquiring orders from healthcare providers, securing insurance authorizations, scheduling patient appointments with accepting physicians, and informing patients about their scheduled visits. Additionally, the specialist will handle renewal authorizations in collaboration with both the physician's office and the insurance payor.

Key Responsibilities:

  • Investigate and resolve issues related to referral claims or payment requests.
  • Ensure accurate coding and diagnosis by physicians to facilitate appropriate referrals and insurance coverage.
  • Maintain an up-to-date understanding of various insurance plans and their coverage details to guarantee proper reimbursement.
  • Educate nursing staff and physicians on any modifications to insurance plans affecting the referral and authorization processes.
  • Stay informed on current CPT and ICD-9 coding practices to ensure accurate referral processing.
  • Utilize clinical knowledge to effectively communicate with insurance companies regarding referrals.

Qualifications:

  • High School Diploma or equivalent is mandatory.
  • A minimum of 3 years of administrative experience in a healthcare environment is required.
  • In-depth knowledge of managed care benefit plans, with at least 1 year of experience in a referral-centric clinic or physician's office.
  • Medical assistant certification from an accredited technical institution is preferred.

Employment Type:

Full Time

Equal Employment Opportunity:

This organization is committed to providing equal employment opportunities to all individuals. We strive to ensure accessibility for all users and welcome inquiries regarding website accessibility or assistance with the application process.



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