Clinical Referral Administrator
1 week ago
Position Overview:
The role entails overseeing the comprehensive referral process within a medical practice. This includes securing orders from healthcare providers, obtaining necessary insurance authorizations, scheduling patient appointments with participating physicians, and informing patients about their appointments. Additionally, the coordinator will manage renewal authorizations with both the physician's office and the insurance payor.
Key Responsibilities:
- Investigate and resolve issues related to referral claims or payment requests.
- Ensure that physician coding and diagnoses are accurate to facilitate appropriate referrals and insurance coverage.
- Maintain a thorough understanding of various insurance plans and patient coverage to guarantee proper payment.
- Educate nursing staff and physicians on updates and changes within insurance plans related to referrals and authorizations.
- Stay current with all relevant CPT and ICD-9 coding to ensure accurate processing of referrals.
- Utilize clinical knowledge to effectively communicate with insurance companies regarding referrals.
Qualifications:
- A high school diploma or equivalent is mandatory.
- A minimum of three years of experience in an office environment within the healthcare sector is required.
- In-depth knowledge of managed care benefit plans, with at least one year of experience in a referral-focused clinic or physician's office.
- Certification as a medical assistant from an accredited technical institution is preferred.
Employment Type:
This is a full-time position.
Equal Employment Opportunity:
We are committed to ensuring that our workplace is accessible to all individuals.
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