Referral Coordinator

4 weeks ago

Los Angeles, United States Illinois Bone & Joint Institute Full time

Description Hinsdale Orthopaedics is currently looking for a full-time Referral Coordinator. The Referral Coordinator is responsible for facilitating the administration of requested medical services for appropriate utilization of resources. This is accomplished by evaluating referral requests for eligibility, benefit determination, preferred provider networks, level of care and medical necessity. Responsibilities Performs the day-to-day tasks of: entering referrals and applying criteria (where necessary). Meets or exceeds Departmental productivity targets on a weekly basis. Maintains files and records of referral activity. Demonstrates initiative, motivation and resourcefulness in day-to-day operations. Demonstrates the ability to utilize medical necessity criteria, scope of benefits and health plan criteria. Works aggressively with physicians and physician office staff to obtain necessary medical information related to referral requests. Assists with cross coverage within the referral management team as assigned. Participates in staff meetings. Customer Service Maintains professional and positive interaction with physicians, offices, members and health plan staff. Presents information in a clear and concise format, ensuring mutual understanding through discussions, questions and feedback. Effectively and efficiently uses time and resources to achieve work related goals, organizing activities according to priority and the need for coordination and cooperation with others. Takes responsibility for assigned work, following through to ensure goals are met or exceeded. Takes responsibility for decisions and/or actions in the job. Demonstrates openness to new ideas and ways of working; adapts to changing needs and situations; approaches issues with an openness to change and a willingness to pursue different approaches to achieve a positive outcome. Works cooperatively and collaboratively with others, contributes to the “team” in its broadest sense; encourages participation, commitment, and an active contribution from him/herself and others in the pursuit of common goals. Actively seeks ways to apply knowledge and skills to help others. Performs other duties as assigned by the manager. Requirements LPN/LVN, Graduate Nurse, or high school graduate with demonstrated medical terminology knowledge. One year experience in the medical or health insurance field. Two years previous referral and/or precertification experience in an office or health plan setting are preferred. Ability to communicate effectively, both written and orally. Ability to multitask in a fast paced environment. Able to work independently. Typing skills. CPT and ICD-9 coding familiarity. Knowledge of Microsoft Office (Word, PowerPoint).

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