Referral Management Coordinator
Department: Central Referral Dept
Job Type: Part Time
Job Class: Union
Union Name: SHLABOR -Laborers Local 381
Work Shift: Days
Work Days: 10:00 am - 2:00 pm
Date Posted: 12/04/2019
Requisition Number: hrq-91759
Performs referral and prior authorization requests for various services requested by third party vendors. Current services include but are not limited to: advanced imagining; surgical day procedures other specialist visits or high cost items such as sleep studies. These requests may be telephone, via paper, or other means such as web based. 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 Work Queue's, In Basket 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. Completes correct forms and/or electronic portals with information required to facilitate referral/authorization re quests 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. Obtain referrals for internal, incoming, and outgoing specialty visits. Follows department and each specific insurance company protocol to acquire referral/authorization numbers. 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. Collect demographic and pertinent information. Enters referral information into department's computer application programs such as Epic, Meditech, etc.
Education/Training: Associates Degree or Bachelor's degree preferred. Work Experience: A minimum of 2 years administrative experience, preferably in a medical setting. Experience in processing referrals. Working knowledge and proficiency in Epic referrals preferred. Skills: Must be an effective team player with strong communication 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.