Referral Coordinator - Special Medicine Clinic

The Referral Coordinator processes referrals for patients seen in the Eskenazi Health Center. This includes : verifying patient insurance eligibility;

communicating with physicians; obtaining prior authorization or precertification when needed; scheduling appointments consistent with patients' insurance plan, and processing all appropriate paperwork.

The Referral Coordinator communicates appropriate diagnostic and clinical information as needed. The Referral Coordinator communicates with all patients in a manner appropriate to their age and development stage.

Essential Functions and Responsibilities

• Serves as patient information liaison between hospitals, insurance companies, physician offices and other departments.
• Processes referrals in a timely manner.
• Processes referral instructions from providers and obtains appropriate appointments.
• Reviews patients' insurance information to ensure provided services are scheduled within the appropriate provider network.
• Provides accurate diagnosis and clinical information to provider of referred services.
• Provides education and clarification to patients regarding their insurance coverage as appropriate.
• Completes and processes appropriate paperwork in accordance with specific insurance requirements.
• Maintains accurate referral records.
• Responds to / facilitates inquiries from patients, physicians, insurance companies and area hospitals regarding benefits / referrals, etc. in a timely manner.
• Establishes effective working relationships with other specialty offices.
• Stays current with insurance and system updates.
• Regularly attends required meetings.
• Adheres to State and Federal safety guidelines.
• May be required to assist with PSA functions.
• Responsible for own professional growth.

Job Requirements

• High School diploma or equivalent (GED) recommended.
• One year experience in health care setting required.
• One year experience working with multiple insurance plans and networks required.
• Must pass multiple system application exams as applicable.
• Medical terminology knowledge preferred.

Knowledge, Skills & Abilities

• Knowledge of hospital and clinic processes and procedures.
• Working knowledge of multiple insurance plans and networks.
• Knowledge of medical terminology.
• Knowledge of IC D-9 / C PT coding.
• Basic computer knowledge and skills with typing speed of 30 wpm.
• Alpha / numeric filing skills.
• Strong organizational skills.
• Well-developed problem-solving skills.
• Effective oral / written communication skills, including the ability to communicate with patients in a manner conducive to the patient's age and developmental stage.
• Ability to :
• operate standard office equipment
• read and understand insurance cards
• relate in a professional and courteous manner to patients and staff
• prioritize work and devise own work patterns / methods and manage large work volumes
• be flexible to changing work duties and priorities
• exercise good judgment and work with minimal supervision
• be detail-oriented
• follow oral / written instructions
• interact with patients from all economic, educational, and social backgrounds
• Treat all patients with dignity and respect
27 days ago