Referral Coordinator

Position Summary

The Referrals Coordinator is responsible for working within the Epic system and insurance portals to process all ACCESS referrals that are generated by the clinical providers, to ensure that the patient is being referred to the appropriate in-network provider, and that the services are approved as stipulated by the patient’s current benefit plan requirements.

Core Job Responsibilities

• Work with Payors/Plans to process referrals/authorizations to completion according to policy and procedure.

• Assist Access Clinic providers/staff in identifying appropriate in-network providers for referred services.

• Assist patients with questions regarding referrals.

• Coordinate with other departments and facilities to ensure appointments are scheduled and patients have received the necessary information for their appointment(s).

• Work/address the referrals that remain open to determine if patient received the referred services. Contact Referred to provider to obtain consultation notes. Contact patients per established policy and procedure to ensure they receive referred services. Close referrals per established policy and procedure.

• Build and maintain relationships with Payor/Plan representatives and ACCESS clinic providers and staff; acts as a resource to answer questions and solve problems

• Maintain accurate information regarding what services require prior authorization for each Payor/Plan.

• Maintain accurate information regarding which external providers are contracted with each Payor/Plan.

• Monitor for delays in the prior authorization process and works with the Prior Authorization Department to ensure timely scheduling.

• Monitor referral phases to maintain compliance

• Monitor referral dashboards and work queues daily

• Perform other duties as assigned.

Requirements/Preferences

• High school diploma or GED required

• Minimum 1-year experience in a clinical office or health care environment in patient registration, referrals, medical assisting or customer service required.

• 1-year EHR Systems experience, preferred, EPIC a plus

• Beginning proficiency Microsoft Office Suite (Word, Excel, Outlook)