Referrals Coordinator

SUMMARY

Responsible to schedule follow up external specialist visits after patients preliminary treatment and as ordered by the doctor. Verify patients’ details and information on medical history and insurance. Inform patients of scheduled visits, preparation and arrangements between the practice, facility and/or the provider referred to.

QUALIFICATIONS/EDUCATION 

  • 1+ years of Office Manager experience.
  • Associate degree or equivalent, preferred.
  • Proficient in MS Office with basic computer and keyboarding skills.
  • Bilingual English/Spanish preferred; must be able to read, write and speak English.

CERTIFICATIONS/LICENSES

  • N/A

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Expediting the administrative requirements for the patient referrals, ensuring that appropriate referrals are made to participating providers with the patients’ health plan, obtaining appointments for Specialist visits, and notifying the patient/member of the appointment.
  • Maintain and provide ongoing tracking and appropriate documentation or reports on referrals to promote team awareness and ensure patient safety.
  • Processes all referral requests according to company policies and procedures.
  • Receives, prioritize, and prepare referral authorization request for the patients.
  • Ensure that referrals are addressed in a timely manner.
  • Data entry of authorization into Electronic Health Records and/or Utilization Review system, ensuring that all referrals are tracked through to a completed visit and a report is received.
  • Verifies member eligibility via insurance carrier as necessary.
  • Contact insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis and prognosis.
  • Assemble information concerning patient’s clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
  • Coordinates and assists with obtaining surgery appointments and rescheduling missed appointments as needed of any type of referral.
  • Review details and expectations about the referral with patients.
  • Remind patients of scheduled appointments.
  • Develops and promotes positive effective customer service relations with patients, and staff.
  • Notifies patients of authorization status and inquiries in a consistently and professional matter.
  • Coordinate the outside transportation for the patients.
  • Directing unresolved issues and request to the appropriate designated resource.

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