Patient Referral Specialist
2 weeks ago
The Referral Coordinator plays a vital role in ensuring seamless patient experiences within the orthopedic practice. This position involves managing patient registration and coordinating necessary referrals and authorizations to facilitate efficient care delivery.
Key Responsibilities
- Ensure accurate patient registration by verifying and updating information in the practice management system.
- Obtain necessary authorizations and benefit verifications for all outpatient visits, procedures, and services.
- Utilize online verification systems to confirm insurance eligibility and maintain accurate records.
- Create and manage referrals for pending visits, ensuring all patient demographic and insurance information is up-to-date.
- Prepare charts daily to support a smooth check-in process for patients and clinic staff.
- Research and gather information required for the registration process from various sources.
- Process a high volume of referrals daily, ensuring timely communication with primary care providers and insurance companies.
- Monitor and inform front office staff of any outstanding patient balances.
- Maintain productivity rates while ensuring timely claims reimbursement and managing work queues effectively.
- Address inquiries from in-house providers and support staff regarding patient referrals and care coordination.
- Identify trends and potential issues, communicating them to management for resolution.
- Index referrals to existing patient accounts and create new accounts for non-established patients.
Qualifications
- High school diploma or equivalent is preferred.
Experience
- Two to three years of experience in a healthcare setting, particularly in referral management, front desk operations, or billing.
- Effective communication skills with the ability to build relationships with physicians, patients, and colleagues.
- Familiarity with Centricity Practice Management and Centricity EMR is advantageous.
Requirements
- Experience with managed care insurances, including the process of requesting referrals and verifying benefits.
- Comprehensive understanding of insurance plan requirements for both Medicaid and commercial plans.
Knowledge
- Proficient in eligibility verification and prior authorization processes for various insurance payers.
- Understanding of government regulations and billing guidelines, including Coordination of Benefits.
- Advanced computer skills, particularly with Windows-based applications.
Skills
- Adept at managing challenging situations while maintaining a pleasant demeanor.
- Proficient in using computer programs and applications effectively.
- Skilled in fostering positive working relationships with both internal and external stakeholders.
Abilities
- Capable of multitasking in a dynamic environment.
- Detail-oriented with strong organizational capabilities.
- Able to interpret patient demographic information and assess insurance eligibility.
- Typing speed of at least 45 words per minute.
Work Environment
- Standard office environment.
Physical and Mental Demands
- Requires typical office-related sitting and standing.
- Some bending and stretching may be necessary.
- Manual dexterity for operating a computer keyboard and calculator.
Organizational Expectations
- Adherence to the mission, vision, and values of the organization is essential.
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