Referral Management Coordinator
Department: Central Referral Dept
Employment Type: Part Time
Job Type: Union
Union Name: SHLABOR -Laborers Local 381
Work Shift: Day/Evening with Variable Start Time
Work Days: 11:00 a.m. to 3:00 p.m.
Date Posted: 07/28/2017
Requisition Number: hrq-76675
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 cli nical follow-up. .Enters approvals, denials, pending referral/authorizations status.
A minimum of 2 years administrative or office experience, preferably in a medical setting. An effective team player with strong inter-personal skills. Must have demonstrated ability to maintain dynamic and responsive interactions with patients, insurers 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. Associates Degree or 4 year College degree preferred