Referral Coordinator (40 hours/week on 1st Shift)

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Summary

Job Description

POSITION SUMMARY: Plans, organizes, directs and coordinates all aspects of the referral office.

HOURS: M-F 8:30AM-5:00PM

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

• Coordinates and monitors daily work flow processes and activities for meeting required referral/insurance deadlines (within 72 hours/or as directed by provider – e.g., Stat/emergent).
• Daily reviews and monitors referral work que in order to provide accurate and timely referral process documentation.
• Serves as the first-line resource for all customers (internal/external) with regards to Insurance and Referrals.  Must be knowledgeable in all areas of insurance verification and authorization/referral processes.
• Maintain accurate and current referral log on all patients.
• Serve as liaison for patient with doctor offices with regards to processing referrals.  Communication may be via fax/telephone/electronically.
• Review and analyze managed care patient visits and ensure proper documentation of required services.
• Coordinate internal functions and recordkeeping related to managed care organizations to meet compliance.
• In collaboration with staff in LG Patient Financial Services, ascertain physician credentialing is current and required documentation on file.
• Organizes in-service programs for staff regarding all referral/insurance process changes and updates.
• Liaison between patient and insurance company to explain to patient what their insurance company requires to meet referral/authorization compliance.
• Must have the ability to communicate in a positive, customer service manner when communicating with all customers or when using Department tools (i.e., telephone, fax, email, voice mail, etc.).
• Exhibits teamwork and excellent customer service skills without exception, at all time for both internal and external customers.
• Collaboratively works with internal/external LG staff, other physician offices, and outside agencies, to resolve patient questions and complaints regarding referral/insurance issues.

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

• Maintains knowledge of registration and scheduling processes with the capability of filling in as needed based on office workload or staffing demands.
• As needed, assist Billing Coordinator with assigned tasks.
• Provide educational sessions to resident physicians and staff.
• Identifies any system dysfunction or discrepancies and reports to Supervisor/Manager, making recommendations for improving current department and hospital-wide procedures.
• Assist with other projects or responsibilities as required by Supervisor/Manager.
• Addresses gaps in care in an attempt to help patients reconcile any remaining health care screenings or surveillances.
• May outreach to patients who expresses a desire for a new LGHP PCP to schedule an appointment.   Outreaches to patients who have not been seen within the prior 18 months at their LGHP PCP office and schedules patients accordingly to maintain their LGHP relationship. 
• Other duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

• High school diploma or certificate
• One (1) year of computer experience
• One (1) year clerical or clinical experience in a medical practice setting
• One (1) year experience in medical insurance

PREFERRED QUALIFICATIONS:

• One (1) year of using medical terminology
• One (1) year experience completing medical prior authorizations
• Basic keyboarding ability and telephone/interpersonal etiquette is required. Successful completion of customer service training module or commensurate experience with successful completion of related competency testing is also required

COGNITIVE REQUIREMENTS

ATTENTION/CONCENTRATION – The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others:

• The position requires the ability to attend to more than one aspect of a situation simultaneously.  It is highly likely that multiple task demands are going to be required of the individual at the same time.

NEW LEARNING AND MEMORY – The following level of ability is essential for the jobholder to learn and retain material:

• The position requires that an individual be able to learn new tasks quickly and effectively.  Job requirements change frequently.  The ability to understand and carry out detailed, involved instructions in mandatory.

PROBLEM SOLVING, REASONING AND CREATIVE THINKING – The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought:

• The position deals with issues or problems that often require thoughtful reasoning before arriving at approaches or solutions.  Some independent thought, planning or origination of options and solutions is necessary.  The individual must have the ability to apply principles of reasoning and problem solving to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

APTITUDES:  The following are essential requirements of the position in relation to job-worker situations.  These items describe how a worker must adapt, adjust, conform or act:

Leadership, control and planning: Ability to accept responsibility for leadership, direction, control, planning, negotiating, organizing, directing, supervising, formulating practices, or making final decisions.

Repetitive work: Ability to continuously perform the same type of work for extended periods of time, according to set procedures, sequence or pace.

Performing under stressful conditions: Ability to perform under stress when confronted with emergency, critical, unusual, or dangerous situations, or in situations in which working speed and sustained attention are critical aspects of the job. Is subject to danger or risk, or to tension as a regular, consistent part of the job.

Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.

Communication:  Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.

Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.

EQUIPMENT USAGE REQUIREMENTS

Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies

Software: Microsoft Office Products, RAS, SMS, EPIC, Sovera, Web Access for validation of eligibility, and other electronic insurance verification tools.

PHYSICAL REQUIREMENTS

Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%

Body Position/Movement:

• Sit: Frequently
• Stand: Frequently
• Walk: Frequently
• Bend: Rarely
• Push: Rarely
• Pull: Rarely
• Kneel/Squat: Rarely
• Reach: Occasionally
• Twist: Rarely
• Balance: Rarely
• Climb: Rarely

Lifting: Degree of physical exertion is:

Light, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.

Sensory Abilities specifically required:

• Vision
• Hearing

PHYSICAL ENVIRONMENT

WORKING CONDITIONS: Exposure to hazardous conditions/ materials is negligible.

          

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job.  It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards.  The percentages of time spent performing job duties are estimates, and should not be considered absolute.  The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole.  Incumbent must be able to perform all job functions safely.

Disclaimer

CAMPUS Full Time Posted on 12/04/2024