Description
At NorthBay Health, the Referral Coordinator coordinates the referral process for patients and physicians utilizing access to care standards for all consults. Responsible to secure accurate patient demographics, authorizations and payer information in a timely manner to ensure patient care is not delayed. Verifies and documents eligibility and benefits for patient's specific payers. Ensures appropriate documentation is in the patient's Electronic Health Record (EHR). Schedules patient appointments and procedures as appropriate, and coordinates transfer of necessary records. Functions as the liaison to physicians and office staff, to expedite department/specialty access to care. Reviews and appropriately schedules patient appointments utilizing Department Specific appointment protocols.
PRIMARY JOB DUTIES
- Gathers, updates and verifies insurance/payer information and ensures accurate entry into the practice management system.
Verifies insurance type and eligibility for care.
Prioritizes referrals based on clinical need as indicated by the ordering provider, and the Medical Services Request Form (MSR).
Completes, and documents, referral / scheduling process for all referrals for initial consult visits, as requested by the ordering provider (includes patient contacts, closure of referral, correspondence notification to PCP, as appropriate).
Observes provider schedules to ensure appointments are booked for correct appointment type and correct time allocation.
Schedules appointments for other specialty referrals and/or other services/procedures. Delivers appropriate information (office visits, labs, radiology reports, etc.) via fax, or in person to the specialty provider.
Schedules appointments and procedures for referrals for numerous Multi-faceted Specialty Care Offices as required.
- Obtains additional information from referring provider when requested by consulting provider.
- Assists in collection and reporting of statistical data, as requested.
Determines priorities for completion of support functions, tasks and projects.
- Provides applicable basic education to patients to optimize the opportunity for customer satisfaction.
- Provides assistance to Patient Services Representatives (PSR) and Medical Assistants as needed with referral duties.
- Backs up PSR positions as needed.
- Consistently demonstrates and promotes a sense of team within the immediate and extended work groups.
- Establishes and maintains effective communication with physicians, co-workers and patients.
- Participates in peer-based evaluations of other staff in specified areas as needed
- Participates in educational programs, staff meetings and in-service meetings.
Performs other job-related duties and responsibilities, as assigned.
- Maintains current competency files per Standards and annual requirements
Qualifications
Education: High school graduate or GED preferred.
Experience: Minimum of one year's experience in a medical front office setting with experience and knowledge of health insurance/ benefit requirements required. One or more year's of experience working with medical insurance plans preferred. One or more years of experience working with referrals/consult processes in the specialty care setting. Examples: Pulmonology, Surgery, Urology, Women's Health, Gastroenterology, Cardiology, Infectious Disease and Endocrinology preferred.
Skills: Strong organizational and written/spoken communication skills essential. Ability to work independently on a variety of complex tasks, managing competing deadlines. In depth working knowledge of Windows and Microsoft Word. Knowledge of ICD-9, ICD-10 and CPT-4 coding Knowledge of medical terminology, and insurance rules and regulations required. Detail oriented with typing and computer input ability and a working knowledge of general office machines required. Strong ability to multi-task; schedule appointments for several multi-disciplinary clinics.
Standards of Performance: Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.
Physical Effort: Attendance is an essential function of the job. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Requires some walking; prolong hours of sitting and standing. Requires use of telephone, writing and computer keyboard six or more hours each day. Requires stooping, bending, reaching, twisting and squatting.
Hours of Work:40 hours per week, pre scheduled between Monday-Friday during established office hours 07:00am-05:30pm and business needs.
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