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Medical Referral Coordinator

2 months ago

Sandusky, Ohio, United States NOMS Healthcare Full time
Job Summary:

This is a clerical position that involves submitting prior authorization for patients. Work is performed in accordance with NOMS policies and procedures/applicable federal and state laws. Effective performance requires independent action under general supervision.

Key Responsibilities:
  • Obtain doctor-to-doctor referrals when scheduling with a specialist, schedule all doctor-to-doctor referrals and diagnostic testing for patients within the requested timeframe.
  • Verify insurance plans to ensure the doctor or facility is in-network prior to scheduling with a specialist or hospital for testing.
  • Obtain prior authorization on all high-tech imaging services, surgical procedures, sleep studies, and psychological services. Some insurance plans may not require authorization, but an attempt must be made. Always obtain the name of the insurance representative and a reference number for the call.
  • Obtain detailed benefit coverage for psychological services, dietary services, surgical procedures, global maternity, injections, and sleep studies with all insurances. Obtain a name and reference number for the benefits quoted.
  • Generate diagnostic orders and fax them to the relevant imaging facility.
  • Notify patients of their scheduled appointments.
Competencies:
  • Knowledge of patient account policies and practices of NOMS.
  • Knowledge of medical terminology.
  • Ability to organize and process work efficiently.
  • Knowledge of computer programs and applications.
  • Ability to independently assume other responsibilities in addition to routine duties.
  • Must be a team player and self-motivator.
  • Ability to communicate clearly.
Education and Work Experience:
  • High school graduation or GED.
  • Typing ability and Word processing/computer skills.
  • At least one year of experience in a medical office setting.
Environmental/Working Conditions:

Office setting, well-ventilated and well-lit. Work involves frequent telephone contact with patients. Work may be stressful at times. Interaction with others is constant and interruptive.

Physical/Mental Demands:

Normal office environment. Work is typically performed at a desk or table requiring the use of standard office equipment. Intermittent sitting, standing, and stooping. May view computer screens for long periods of time. Work may be stressful at times. Interaction with others is constant and interruptive.

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

NOMS is an equal opportunity employer committed to high standards of business conducted and civic responsibility. This includes our policy of offering fair and equal opportunities to every employee or applicant for employment regardless of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation) age, national origin, disability or genetic information, or status as a Vietnam-Era or special disabled veteran, or any other protected classes, in accordance with applicable law.