(Archived) Referral Coordinator

Referral Coordinator/Insurance Verification

Responsibilities:

• Prioritize and process all incoming referrals for designated regions.
• Obtain all appropriate information and documentation to process the referral.
• Obtain any other pertinent medical information about the patient for the clinician.
• Work with the nursing home and/or family to determine if the resident has Medicare, Medicaid or a supplemental insurance.
• Ensures quality and accuracy of the patient insurance information, and that listed patient demographics, certification periods, billing addresses, policy numbers, authorization numbers, etc. are all entered correctly.
• Verify Medicare, Medicaid, or Commercial Insurance, via telephone or online systems. Re-verify all insurance monthly for referrals that are still in process.
• Obtain necessary written or verbal consent for services either by phone, email, or mailing the form to the designated financial responsible party.
• Ensure all referral documentation is uploaded in the patient’s chart.
• Serve as a resource for questions regarding referrals.
• Maintain current information for critical referral contacts for all your assigned regions.
• Notify clinicians when referrals are ready to be seen (RTBS).
• Respond to calls, emails and other inquiries regarding the status of outstanding referrals within one business day.
• Communicate efficiently, effectively, and timely to resolve issues pertaining to referrals.
• Attend monthly staff meetings.
• Assists co-workers when necessary.
• Other duties as assigned.

• 2+ years experience of related healthcare experience with the insurance verification & processes. Referral & Authorization experience is a plus.
• Must know the difference from HMO/PPO/MCO plan when pulling up CSNAP to verify Medicare.
• Strong organization skills & the ability to multi-task and work independently.
• Understanding of medical terminology and clinical documentation.
• Assures confidentiality of all information. Demonstrates knowledge of standards, policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
• The ability to meet deadlines, create and follow work plans, while maintaining flexibility, is a must.
• Must be able to resolve conflict, coordinate, listen, work independently as well as work as a team player on various projects.
• The applicant must be personable and able to communicate well with administrative and clinical staff, both in writing and verbally.
• High energy, flexible, optimistic attitude with ability to handle multiple demands.
• Proven attention to detail and promotes a commitment to quality.
• Must be proficient in the following software: Microsoft Word, Microsoft Excel, Microsoft Access, and Outlook.
• Minimum High School Diploma or equivalent