Medical Referral Coordinator

4 weeks ago


Honolulu, Hawaii, United States Kalihi Palama Health Center Full time
Job Title: Medical Referral Specialist

At Kalihi-Palama Health Center, we are seeking a highly skilled Medical Referral Specialist to join our Patient Centered Health Care Home team.

Job Summary:

The Medical Referral Specialist will play a vital role in providing patient-centered healthcare by performing utilization management activities, monitoring patient referral insurance paperwork, and ensuring timely and accurate authorization of referrals to external agencies and/or consultants.

Key Responsibilities:
  • Monitor patient insurance status to ensure timely and accurate authorization of referrals for service and drug assistance.
  • Communicate with clients regarding appropriate use of medical benefits as it pertains to existing referrals.
  • Support physicians and their staff to accurately complete referral paperwork and drug assistance authorization.
  • Create and maintain computer and/or manual referral logs.
  • Verify patient eligibility for insurance coverage and authorize approval for referrals as permitted by insurance plan guidelines.
  • Verify participation with various insurance plans to ensure maximum reimbursement and most cost-effective selection of referral services source.
  • Follow up on patient referrals by calling specialists and tracking open orders as necessary.
  • Track specialists' performance and maintain accurate and timely documentation.
Requirements:
  • High School Diploma or GED required, Post-secondary education preferred.
  • Formal training in Medical Terminology required.
  • Certified or registered Medical Assistant preferred.
  • Experience in clinical setting required, previous experience in utilization management preferred.
  • Experience in CPT, ICD9 coding preferred.
What We Offer:

Kalihi-Palama Health Center is an equal opportunity employer that is committed to diversity and values the ways in which we are different. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.



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