Referral Coordinator

Overview

Halifax Health is seeking a Referral Coordinator.

Summary

This individual is responsible for leading a team in obtaining referrals and authorizations. The Coordinator will also be expected to complete pre-registration screening, as required by insurance companies along with practice policy for a large multiple provider/location practice.

Job Qualifications

• High School Diploma or GED equivalent required; Associate's or Bachelor's degree preferred

• Two years of experience in referral and authorization fields required

• Microsoft Office applications knowledge required

• Understanding of medical office operations related to patient registration, referrals, authorization & revenue cycle preferred

Job Duties and Responsibilities

• Ensures that all required referrals and or authorizations for patient visits have been obtained.

• Resolves pre-certification and registration concerns prior to a patient's appointment.

• Reviews details and expectations regarding referral and authorization process with patients and/or family.

• Gathers pertinent information from insurance carriers and staff to determine patient responsibility.

• Serves as primary resource on all departmental referral and authorization matters.

• Develops, implements, and monitors departmental progress, resource tools, and report findings on a regular basis.

• Communicates with management and staff regarding insurance carrier contractual and regulatory requirements.

• Demonstrates overall knowledge of authorization, benefits and claims processing for insurance companies and plans both private and government.

• Contact review organizations and insurance companies to ensure prior approval requirements are met.

• Present necessary medical information such as history, diagnosis, and prognosis.

• Researches and corrects invalid or incorrect patient demographic information.

• Coordinate appointments as needed with outside facilities and specialist.

• Assists with logistical and/or clerical problem resolution related to the patient's medical record, authorization and billing issues.

• Follows through with any problems or questions in a timely manner, by understanding and using resources available for problem solving in a diplomatic and tactful manner

• Schedule and supervise staff of ambulatory office referral specialists

• Educates and trains staff on referral management, authorizations, and pre-registration

• Works with leadership to establish and maintain effective policies and procedures for referrals, authorizations, revenue cycle, and co-payment collection for the department

• Contacts patients for updated insurance information, when applicable.

• Prepares reports of daily activity as requested for management.

• Performs financial reviews and calculations based upon information received from the insurance company or plan.

• Participates in meetings reporting statistical referral, authorization, and pre-registration measurements and indicators, and communicating required information.

• Assists management in month end reporting as requested.

About Us

Recognized as one of the 50 Top Cardiovascular Hospitals in the United States by IBM Watson Health, Halifax Health serves Volusia and Flagler counties, providing a continuum of health care services through a network of organizations including a tertiary hospital, two community hospitals, urgent care clinics, psychiatric services, a cancer treatment center with five outreach locations, the area's largest hospice, a center for inpatient rehabilitation, outpatient rehabilitation clinics, primary care walk-in clinics, a clinic specializing in women's health, a pediatric care community clinic, five pediatric medical practices, a home health care agency and an exclusive provider organization. Halifax Health offers the area's only Level II Trauma Center, Thrombectomy-Capable Stroke Center (TSC), Center for Transplant Services, Pediatric Intensive Care Unit, Child and Adolescent Behavioral Services, complete Neurosurgical Services, OB Emergency Department and Level III Neonatal Intensive Care Unit that cares for babies born earlier than 28 weeks. For more information, visit halifaxhealth.org.