Referral Coordinator - Orthopedic Clinic

Salinas Valley Health Clinics - Orthopedic Clinic

SUMMARY

The person in the position of the Referral Coordinator must be able to perform the duties described within as well as to meet the company’s qualifications. The referral coordinator must have exceptional communication skills to communicate effectively with clinic managers and referring providers. Individuals must be organized, and be able to manage a demanding workload with accuracy.

ESSENTIAL DUTIES AND RESPONSIBILITIES

specific to the authorization department include the following:

• Responsible for the completion of all incoming/outgoing referrals as assigned.
• Maintain ongoing tracking and appropriate documentation on the status of referrals. Referrals should be addressed in timely manner, by reviewing and reconciling overdue and/or pending orders in the work queue.
• Referrals should be addressed in timely manner, by reviewing and reconciling overdue and/or pending orders in the work queue. Escalate routine referral delays more than 14 business days.
• Assemble information concerning patient’s clinical background and referral needs.
• Knowledge and understanding of ICD-10 and CPT Codes
• Contact insurance companies to ensure all prior authorization needs are met. Present necessary medical information such as history, diagnosis and prognosis.
• Be the system navigator and point of contact for patients with outstanding referrals, assuring patient is aware of referral by reviewing details and expectations.
• Contact external offices to ensure referral is received, to obtain patient appointment date, including all relating information.
• Ensure the patient’s chart is up to date with demographics, insurance information, and information on specialist consults; scanning appropriate follow-up documents into system.
• Scans all patient visit documentation into EHR
• Covers various front office positions as needed
• Other duties as assigned

QUALIFICATIONS

For the employee to execute this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

The employee performing this position is expected to hold a High school diploma or general education degree (“GED”); and at least three months (preferably six months) related experience (e.g., health care setting, customer service, etc.) and/or training; or equivalent combination of education and experience. The employee performing this position is expected to have some experience with medical terminology and understanding of medical insurance process. S/he must be able to understand or quickly learn about the differences between and among patients with private insurance, Medicare, Workers’ Compensation and self-paying patients, etc.

PREFERRED

Bilingual may be required during certain shifts.

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.