Referral Coordinator

ESSENTIAL FUNCTIONS
· Verifies and updates patient registration information in the practice management system.
· Obtains benefit verification and necessary authorizations (referrals, precertification) before patient arrival for all ambulatory
visits, procedures, injections, and radiology services.
· Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance
eligibility.
· Creates appropriate referrals to attach to pending visits.
· Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms
as necessary to allow processing of claims to insurance plans.
· Completes chart prepping tasks daily to ensure a smooth check-in process for the patient and clinic.
· Researches all information needed to complete the registration process including obtaining information from providers,
ancillary services staff, and patients.
· Fax referral form to providers that do not require any records to be sent. Be able to process 75-80 referrals daily. For primary
specialty office visits, fax referral/authorization forms to PCPs and insurance companies in a timely fashion.
· Reviews and notifies front office staff of outstanding patient balances.
· Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue
goals.
· Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals,
care coordination, or follow-up status.
· Identifies and communicates trends and/or potential issues to the management team.
· Index referrals to patients account for existing patients.
· Create new patient accounts for non-established patients to index referrals.
EDUCATION
· High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
· Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role.
· Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working
relationships with both internal and external customers.
· Working knowledge of Centricity Practice Management and Centricity EMR a plus.
REQUIREMENTS
· Must have healthcare experience with managed care insurances, requesting referrals, authorizations for insurances, and
verifying insurance benefits.
· In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.
KNOWLEDGE
· Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial
payers, and other funding sources.
· Knowledge of government provisions and billing guidelines including Coordination of Benefits.
· Advanced computer knowledge, including Window based programs.
SKILLS
· Skilled in defusing difficult situations and able to be consistently pleasant and helpful.
· Skill in using computer programs and applications.
· Skill in establishing good working relationships with both internal and external customers.
ABILITIES
· Ability to multi-task in a fast-paced environment.
· Must be detailed oriented with strong organizational skills.
· Ability to understand patient demographic information and determine insurance eligibility.
· Ability to type a minimum of 45 wpm.
ENVIRONMENTAL WORKING CONDITIONS
· Normal office environment
PHYSICAL/MENTAL DEMANDS
· Requires sitting and standing associated with a normal office environment.
· Some bending and stretching are required.
· Manual dexterity using a calculator and computer keyboard.
ORGANIZATIONAL REQUIREMENTS
· HOPCo Mission, Vision, and Values must be acknowledged and adhered to.