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Referral Coordination Specialist

2 months ago

San Antonio, Texas, United States Christus Health Full time

Position Overview:

The role of the Referral Coordination Specialist is pivotal in managing the comprehensive referral workflow within a healthcare environment. This includes tasks such as 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, this position involves renewing 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 appropriate referrals and insurance coverage.
  • Maintain a thorough understanding of various insurance plans and their coverage details to guarantee correct payment processes.
  • Educate nursing staff and physicians on updates and changes in insurance plans relevant to the referral and authorization procedures.
  • Stay informed about current CPT and ICD-9 coding practices to ensure accurate referral processing.
  • Utilize clinical knowledge to effectively communicate with insurance companies regarding referrals.

Qualifications:

  • A High School Diploma or equivalent is mandatory.
  • A minimum of 3 years of experience in an administrative role within a healthcare setting 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.
  • Medical assistant certification from an accredited technical institution is preferred.

Employment Type:

This is a Full-Time position.

Equal Employment Opportunity:

We are committed to creating an inclusive environment for all employees.