Referral Coordinator Specialist

2 weeks ago


Pharr, Texas, United States MyCare Medical Group Full time

Job Title: Referral Coordinator

Job Summary:

The Referral Coordinator will be responsible for preparing and processing all managed care referral paperwork. They will manage the process of scheduling patients for exams and procedures with specialists and providers outside of the primary care physician's office.

Key Responsibilities:

  • Process patients' referrals and ensure that patients are scheduled for their recommended non-PCP appointments.
  • Liaise between Medicare patients/offices and the providers, making sure to effectively process, monitor and communicate all aspects of the patients' referrals.
  • Maintain a list of all preferred specialists and ancillary providers for the assigned area.
  • Obtain referral authorizations if required by the health plan.
  • Communicate respectfully and effectively with patients regarding appointments.
  • Follow guidelines/workflows to complete & log all referrals processed through the system.
  • Meet monthly/quarterly goals regarding utilization and process of ordered referrals.
  • Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.
  • Assist with coordination of activities related to insurance pre-certification/authorization.

Requirements:

  • High school diploma or GED equivalent.
  • Two (2) years of experience as a Referral Coordinator with experience working with the following payors: Cigna, Humana, WellCare, Superior, Aetna, UnitedHealthcare, BlueCross BlueShield, and Molina Healthcare.
  • Bilingual (Spanish) preferred.

Benefits:

  • Comprehensive benefits package, including Health, Vision, Dental, and Life insurances.
  • PTO Accrual and Holidays.


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