Clinical Referral Specialist

7 days ago

Oklahoma City, Oklahoma, United States Cohesive Healthcare Management Full time
Job Description

**Job Summary:**

Cohesive Healthcare Management is seeking a highly organized and detail-oriented Referral Coordinator to join our team. The successful candidate will be responsible for coordinating referral operations at assigned clinics, establishing and standardizing systems and procedures for distributing and using health information throughout the organization.

Key Responsibilities:

  • Develop and implement referral policies and workflows to ensure timely and efficient processing of referrals.
  • Collaborate with healthcare providers and specialists to ensure accurate and complete demographic, insurance, and clinical information is sent to referred specialists.
  • Communicate with insurance companies to ensure prior approval requirements are met and present necessary medical information to support medical necessity of services.
  • Review referral details and expectations with ordering providers and patients, and request new referrals as necessary.
  • Develop and implement systems to meet EMR functionality and regulatory agency requirements.
  • Identify and utilize community resources, establish relationships with servicing providers and personnel, and serve as a point of contact for patients and specialists.
  • Assist with daily patient billing calls and ensure complete billing workflow for all worker's comp claims.

Requirements:

  • Bachelor's degree in a related field or equivalent experience.
  • Proven experience in billing, invoicing, or accounting, with strong attention to detail and numerical accuracy.
  • Excellent communication and interpersonal skills, with the ability to work independently and as part of a team.
  • Strong problem-solving and analytical abilities, with the ability to prioritize tasks effectively.
  • Experience in medical billing or a related field is preferred.

Physical Demands and Work Environment:

The physical demands described here represent those that must be met by an employee to perform the essential functions of this position successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. The physical demands described here represent those that must be met by an employee to perform the essential functions of this position successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to work inside a clean, well-lit work environment. While performing the duties of this position, the incumbent is regularly required to talk or hear. The employee must frequently use hands or fingers to handle or feel objects or controls. The employee is occasionally required to stand, walk, sit, reach with hands and arms, climb or balance, and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities this position requires include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus. The noise level in the work environment is usually moderate. The employee may be required to travel to various locations.

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