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JOB SUMMARY
The mission of the Referral Coordinator is to facilitate and ensure continuity in completing referrals/orders and prior authorizations requested by a provider. This role will understand the intricacies of providing high value referrals across geographic regions and different insurance plans. Works independently to complete prior authorizations and orders based on documentation in the EMR, accessing the provider when necessary and collaborates patient care with the Patient Advocate and Clinical Coordinator.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Will be cross trained on Patients Advocate and Clinical Coordinator responsibilities
- Provide clinical coverage by answering clinic phones and other duties as needed
- Notify patient that referral/order or prior authorization has been completed and ask if there are any barriers to completion of referral or accessing authorized service.
- Works with Director, Patient Care Navigation to ensure patients are receiving high quality low costs specialists/imaging. Reporting issues as they arise.
- Will adhere to all client specific responsibilities and duties.
REQUIRED KNOWLEDGE, SKILLS, & ABILITIES
Required:Â
- CMA preferred or 5 plus years as a referral coordinator
- 2+ years of experience working in healthcare setting with referral, provider and/or insurance experience
- Current certification in Basic Life Support
- Managed care insurance experience
- Demonstrated problem solving skills
- Ability to communicate effectively with patients and providers
- Knowledge of the concepts and principles of insurance networks
- Demonstrated ability to be highly organized around time sensitive tasks
- Knowledge of the healthcare industry and available patient resources
- Knowledge of HIPAA confidentiality requirements
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