Referral Coordinator

Medix is hiring for a Referral Coordinator to support a health center in Providence, RI! This is a full time, on-site position supporting a great team within one of the longest standing primary healthcare groups in the area.

Job Responsibilities:

• Monitors the electronic health record to receive and process requests for referrals and diagnostic imaging prior authorizations during standard clinical hours.
• Able to prioritize and successfully process referrals and related forms from multiple providers.
• Proactively reviews new referrals and diagnostic imaging prior-authorization requests for completeness and accuracy. Able to interpret standard insurance guidelines to identify incomplete referrals before processing, and communicates directly with the care team regarding any necessary testing or records required for approval.
• Has a clear understanding of insurance plans, with knowledge of covered services and community specialists within the insurance company's network.
• Functions as a liaison between insurance companies and care teams for high risk referrals and diagnostic imaging requests. Access insurance companies web-based program(s) to check the status of pending prior authorizations.
• Escalates all unresolved high risk referral issues back to the care team in a timely manner.
• Ability to navigate, read and interpret the patient's electronic medical record for diagnoses, CPT/ICD-10 codes, orders, labs, and imaging (i.e., MRIs, CT Scans, Ultrasounds, X-rays, etc.).
• Works indirectly with patients to facilitate appointments with community specialists.
• Contacts patients by telephone when necessary to assist with making specialty appointments.
• Has knowledge of local community specialists, insurance requirements and how to refer a patient to those specialists. Uses standard reports for tracking referrals, interprets information to identify delinquent high risk referrals, and relays appropriate information back to the clinical teams in a timely manner
• Manages incoming calls to the Referral Department line.
• Maintains ongoing tracking and appropriate documentation within the referral to communicate referral status and ensure patient safety. Verifies accuracy of service centers (specialist names / addresses / phone and fax numbers) and notifies the department supervisor of any necessary.
• The relative production expectation for a Referral Coordinator is to process 25 referrals and prior-authorizations during a standard shift, as well as, schedule time within the day to follow-up on referrals as outlined in company policies and procedures.

Job Requirements:

• Excellent oral and written communication skills and the ability to effectively communicate medical and behavioral health conditions to specialists.
• Ability to work independently and as part of a health care team.
• Basic knowledge/experience in navigating web based portals required, as well as, Microsoft Office products such as Excel, Word, and Outlook.
• Attention to detail required.
• Medical Terminology required. Outstanding interpersonal skills as well as neat and professional appearance are mandatory.
• Experience with processing prior authorizations and referrals.
• Knowledge of state and federal health care programs, including Medicaid, Medicare and other public benefits programs, preferred.

Schedule:

Monday- Friday
Mon, Weds, Friday: 8am- 5pm
Tues/ Thurs: 11am- 8pm

Interviews are taking place now! Apply today!

Medix is acting as an Employment Agency in relation to this vacancy.