IM Referral Coordinator

Referral Coordinator

Internal Medicine

First Shift

Job Summary of Referral Coordinator:

The Referral Coordinator is a multi-tasking position that consists of all aspects of the referral process, prior authorizations and precertification for patients in need of external consultation, Digital Imaging and clinical procedures as requested by the primary care providers. The Referral coordinator will be responsible for scheduling procedures, tracking, referral management and providing reports. The Referral Coordinator will represent Day Kimball Medical Group professionally and positively to enhance and promote the core values and mission of Day Kimball Healthcare by always exercising utmost discretion, utilizing diplomacy and tact in customer interactions. The Referral Coordinator works under the Medical Practice Supervisor collaborates with the clinical staff as well.

Essential Responsibilities of Referral Coordinator include:

• Demonstrates excellent patient relations skills on the phone and in person

• Ensures complete and accurate patient demographics and current insurance information.

• Processes patient referrals to specialty providers by preparing medical records for patient referral to include appropriate visits and clinical information to the specialist

• Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.

• Obtain authorizations for patient referrals to specialists, diagnostic testing and procedures. Advise physicians/providers if authorization request is denied.

• Acts as a resource for patients or providers who have questions or problems relating to referrals.

• Notification to the patients when authorization and pre-certs are obtained.

• Assist patient by providing specialty contact and location information to the patient.

• Using Order Facilitator, book all DKH performed testing with the patient when prior authorization is obtained.

• Review details and expectations about the referral with patients.

• Ensure the referrals are addressed in a timely manner/ 24 hours for referrals/imaging/procedures that do not require a prior authorization and 72 hours for referrals/imaging/procedures requiring authorization and precertification.

• Identify and utilize cultural, language and community resources. Establish and maintain relationships with identified service providers

Knowledge, Skills & Abilities:

• Ability to perform detailed assignments, work accurately, follow directions and assess priorities.

• Accurate and timely processing of all referral management (>97% )

• Excellent telephone skills as measured by random audits, and the absence or presence of patient complaints

• Demonstrated competencies with navigation of insurance websites

• Demonstrated competencies Word, Excel programs

• Adherence to established attendance and tardiness policies

• Demonstrated excellence in customer service

• Demonstrated competencies insurance knowledge

• Must demonstrate the ability to interact with personnel of all levels within the organization and work within a multi-disciplinary team environment.

• Demonstrate excellent interpersonal skills, customer orientation and an outgoing and pleasant demeanor

Qualifications:

• High school diploma or equivalent

• Medical Assistant Certification preferred

• College level courses preferred but not required

• Comprehensive knowledge of Insurances in regard to coverage and prior authorizations/certifications required.

• Demonstrated medical coding knowledge

• Proven competency in medical terminology

• Minimum of 1 year Medical Assistant experience, preferably with Insurance verification and authorizations

• Prior experience and demonstrated competence with patient and Electronic Medical Records