Referral Coordinator

Accountabilities: • Process and coordinate patient referrals in a timely and accurate manner, ensuring all required information and approvals are obtained.

• Obtain physician approval for referrals and hospital admissions, coordinating with relevant healthcare professionals when necessary. • Act as a liaison between patients, physicians, insurance companies, specialists, and other healthcare providers to facilitate seamless referral management. • Contact insurance companies to obtain referral numbers, pre-certifications, and authorizations for medical procedures, specialist consultations, and hospital admissions. • Follow up with insurance providers regarding pending authorizations and ensure that referral requests are progressing within required timelines. • Schedule hospital admissions, outpatient procedures, and diagnostic tests, ensuring patients receive timely appointment information. • Notify patients of scheduled appointments and provide referral or authorization numbers as soon as they become available, ideally on the same day. • Document referral numbers, authorization details, and relevant information accurately in patient medical records. • Obtain and forward medical records from specialists and hospitals to support referral processing and authorization requests. • Fax referral documentation to specialists and direct patients to appropriate healthcare providers and vendors based on their insurance coverage. • Answer incoming telephone calls professionally, take accurate and complete messages, respond to non-clinical patient and family inquiries, and route clinical or other specialized questions to the appropriate personnel. • Maintain accurate records and follow established telephone communication and business office procedures. • Explain insurance-related information, including co-payments, co-insurance, deductibles, and coverage benefits, to help patients understand their financial responsibilities. • Manage additional administrative projects and responsibilities as assigned. • Provide support to other practices when necessary to accommodate patient volumes, staff absences, or operational requirements.

Requirements:

• High school diploma or equivalent required. • At least one year of ICD-9 and CPT-4 coding experience is preferred. • Previous experience working with computers is required, with the ability to use standard office applications and administrative systems. • Strong knowledge of medical insurance plans, coverage benefits, referral procedures, and authorization requirements. • Familiarity with CPT, HCPCS, and ICD-10 coding systems, as well as co-insurance, co-payments, and deductibles. • Understanding of medical terminology and healthcare office procedures is preferred. • Proficiency in Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint. • Ability to type at least 50 words per minute accurately and operate standard office equipment, including computers and photocopiers. • Excellent verbal and written communication skills, with strong English reading, writing, speaking, grammar, spelling, and punctuation abilities. • Professional telephone etiquette and the ability to communicate clearly, pleasantly, and effectively with patients, families, physicians, and insurance representatives. • Strong customer service skills, with a patient-centered approach and the ability to handle inquiries professionally and empathetically. • Excellent organizational and time-management skills, with the ability to prioritize multiple assignments, manage frequent interruptions, and meet strict deadlines. • Strong attention to detail and accuracy when processing referrals, documenting patient information, and handling medical records. • Effective problem-solving and critical-thinking abilities, particularly when navigating insurance requirements and referral challenges. • Ability to follow written and verbal instructions and work both independently and collaboratively within a team. • Flexibility to support other practice locations when operational needs require additional assistance. • Additional language skills are considered an advantage.