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Job Details

Referral Management Coordinator

Category: Clerical and Administrative Support
Location:
Malden, MA

Department: Central Referral Dept
Employment Type: Full Time
Job Type: Union
Union Name: SHLABOR -Laborers Local 381
Work Shift: Days
Work Days: 8:30 a.m. to 5:00 p.m.
Hours/Week: 40
Date Posted: 08/07/2017
Requisition Number: hrq-76674

Job Details

  • Job Duties: 

    • Verifies insurance eligibility and benefits for all new, repeat and pending referral/authorization requests. • Submits, tracks and obtains referral numbers and prior authorizations from payors by submitting payor specific, medical necessity documentation to payors. • Based on Epic inbasket orders and/or fax requests, effectively communicate with payors to submit, track, follow-up and obtain referral/authorizations, in a timely manner via websites, software, fax and telephone. • Submits, tracks, receives and obtains insurance authorizations for in-network and out-of-network services. • Collects demographic and pertinent information. Enters referral information into department's computer application programs such as Meditech, Epic, etc. • Completes correct forms and/or electronic portals with information required to facilitate referral/authorization requests to include, but is not limited to ICD-10/CPT codes and diagnostic descriptions, number of visits, specialist information and date of service, medical record documentation, as appropriate. Follows department and each specific insurance company protocol to acquire referral/authorization numbers. • Maintains an effective record keeping system that includes a checklist for contacting insurance companies, patients and specialists or outside service facilities, and a tickler file for follow-up and pending referral/authorization requests. • Notifies providers or provider designee to ensure referral authorization turnaround time standards are met. Researches all referral/authorization cases that are pending and unable to be processed. Notifies providers immediately of denials or other problems impacting referral/authorizations. Works closely with the provider's staff to expedite the submission of additional information to the insurance company. Communicates with clinical staff regarding any issues or that which require clinical follow-up. • Enters approvals, denials, pending referral/authorizations statuses

    Qualifications: 

    A minimum of 2 years of medical referral coordinator experience in submitting requests, medical necessity documentation and obtaining referral authorizations directly from insurance companies for facilitating timely and patient referrals/authorizations. An effective team player with strong interpersonal skills. Ability to maintain dynamic and responsive interactions with patients, insurance companies and medical professionals. Demonstrated ability to work and make decisions in a fast paced environment. Proficient in Microsoft Office and other windows-based computer application programs (such as Epic and Meditech). Familiar with insurance eligibility applications such as Passport and insurance company portals. [cha072516]

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