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Clinical Referral Coordinator
2 months ago
Position Overview:
The role of the Referral Coordination Specialist involves overseeing the complete referral workflow. This includes securing orders from healthcare providers, obtaining necessary insurance approvals, scheduling patient appointments with physicians who accept specific insurance plans, and informing patients about their appointments. Additionally, the specialist will handle 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 proper referrals and insurance coverage.
- Maintain comprehensive knowledge of various insurance plans and their coverage details to guarantee appropriate payment.
- Educate nursing staff and physicians on updates regarding insurance plans related to referrals and authorization processes.
- Stay informed about current CPT and ICD-9 coding standards to ensure accurate referral processing.
- Utilize clinical knowledge to effectively communicate with insurance companies regarding referrals.
About CHRISTUS Health:
CHRISTUS Children's Hospital, a pioneer in pediatric care since 1959, serves a vast community of children annually. This institution is dedicated to providing specialized medical services tailored to the unique needs of children, including intensive care, emergency services, and advanced treatment options for various conditions.
Qualifications:
- A High School Diploma or equivalent is mandatory.
- A minimum of 3 years of experience in an administrative role within a healthcare environment is required.
- In-depth knowledge of managed care benefit plans, with at least 1 year of experience in a referral-centric 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:
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