Scope of the Job
This position is responsible for processing referral requests for all providers practicing within the clinic module and ensuring that when needed, referral/authorization numbers are obtained for these services.
Access to specialty and ancillary services is a key component of the satisfaction of our patients and referring providers. The responsibilities of this position are extremely important in meeting or exceeding customer satisfaction.
The essential functions are the primary dimensions for performance review.
Attends Referral training class and various referral system training classes within 1 st month of employment
Attends and actively listens and participates in the regularly scheduled Referral Coordinator meeting
Process referrals for services requested by Providers within established guidelines, to include external referrals
Obtains authorizations for referrals and schedules appointments as appropriate and within required timeframes
Processes requests for additional referrals/authorizations when requested by providers
Assures referrals are maintained within appropriate network or payer requirement
Provides a standard of excellence as it relates to customer service and satisfaction for all customers.
Communicates with all stakeholders, staff, providers, payers and patients as appropriate and per procedure
Remains current on referral policies and procedures, payer requirements and Managed Care Matrix utilizing the various on-line resources
Documents required information into the appropriate systems
Maintains patient privacy
Performs routine CSR duties as required
Adheres to all regulatory requirements such as JCAHO, CLIA, HIPAA, etc.
Must be able to perform under stress when confronted with emergency, critical, or unusual situations. Must be capable of dealing with periodic cyclical workload pressures and levels of responsibility. Required to make independent judgments without supervision. Must be able to make generalizations, evaluations, or decisions based on sensory or judgmental criteria. Must have the adaptability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure. Requires the ability to work with people beyond giving and receiving instructions.
SKILLS, QUALIFICATIONS, AND REQUIRED EXPERIENCE
1) Knowledge of insurance plans and guidelines; 2) Ability to obtain authorizations and pre-certifications from insurance plans; 3) Excellent customer service skills; 4) Ability to multitask in a fast paced environment; 5) ability to communicate effectively, both written and orally; 6) Above average organizational skills
- 2 years experience in the field or in a related area;
- Minimum of 2 years customer service experience;
- Minimum of 2 years with third party payers (insurance carriers) using commonly used concepts, practices and procedures in the field.
- Computer experience required.
Education and Certifications
High school diploma or GED equivalent required. ICD-9 and CPT coding experience preferred. Completion of a medical terminology course preferred.