Referral Coordinator is responsible for processing all incoming referrals by various methods including external physicians and APPs, insurance payers, online presence, etc. Responsibilities include obtaining, validating, and tracking of referrals/prior authorizations/reauthorizations with requirements that vary based on patient insurance plans.
- Communicate, build relationships, and liaise between PCPs, other specialists, and patients in referral approval process
- Perform chart prep audits to identify and work missing referrals/authorization prior to patient appointments (timing is critical)
- Incoming/Outgoing phone calls to patients, other medical practices, and medical insurance companies
- Work daily batch files, print, scan, and route documents and carefully verify in patient’s electronic chart
- Complete authorization requests via phone, online portal, fax, etc.
- Ensure documentation requirements are met for both insurance carrier and patient medical record
- Verify patient eligibility & benefits via online hub, portal, or live calls
- Understand medical insurance and benefit details to assist with patient education
- Communicate effectively with internal teams and serve as a resource for physician liaisons, physicians/APPs and clinic staff, patients, and other third parties as it relates to referrals and authorizations
- Schedule patient appointments in multiple system platforms
- Priorize tasks with moderate supervision (work STAT requests urgently and accurate)
- Ability to understand related metrics and create process improvements that align with goals