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Employment Type:

Full time

Shift:

Day Shift

Description:

SUMMARY: The Referral Coordinator maintains, confirms, coordinates and/or secures referrals, authorizations, and pre-certifications for incoming and outgoing referrals and diagnostic testing, verifies the accuracy and completeness demographics, insurance providers and payers on outgoing and incoming referrals, and follows standard workflow for referral management.

**SUMMARY:** The Referral Coordinator maintains, confirms, coordinates and/or secures referrals, authorizations, and pre-certifications for incoming and outgoing referrals and diagnostic testing, verifies the accuracy and completeness demographics, insurance providers and payers on outgoing and incoming referrals, and follows standard workflow for referral management.

Referrals:

Properly maintains and tracks referrals from beginning to end.

Accountable for the referral loop by tracking all referral orders including but not limited to specialty referrals and diagnostic referrals.

Tracks, monitors, and manages appointment notifications and messaging within Great Lakes Health Connect and other health information exchanges.

Answers, responds to and documents phone calls, requests and questions from patients, physicians, ancillary services or specialty offices in a timely manner. Calls must be accurately managed or redirected as appropriate.

Assembles information concerning patient’s clinical background and referral needs.

Per referral guidelines, provides appropriate documented clinical information to specialists.

Reviews details and expectations regarding the referral with patients.

Communicates any prep instructions via documented orders or protocol to patient.

Receives and reviews referral requests; prioritizes orders based on urgency.  Schedules, problem solves, communicates, and coordinates referral appointments with patient, physician(s), specialists and/or central scheduling.  Collaborates with essential care team members including physicians, mid-level providers, LPN's, MA's, Practice  Maintains patient confidentiality and abides by all HIPPA guidelines.

Authorizations

Obtains necessary authorization for referrals and diagnostic testing in timely fashion with proper documentation.

Works denied claims for missing prior authorization or referral within the EMR system.

Maintains up-to-date knowledge of referral/payer prior authorization requirements, eligibility guidelines and documentation requirements.

Communicates insurance decisions to patient.

Conducts follow up calls as necessary to physician offices, patients and payers to complete pre-certification process.

Care Coordination

Confirms payer is in-network with specialist. If not, contacts patient to discuss and make alternate arrangements as necessary per payer guidelines in communication with the care team.

Managers, Care Managers, and Operations Director to ensure that patient safety, continuity of care and gaps in care are addressed.

Continuing Education

Maintains and updates reference materials as they pertain to insurance carriers.

Participates in organizational meetings as assigned.

Other

Performs other related duties as assigned

QUALIFICATIONS:

Education Minimum: High School diploma or equivalent required

Preferred: Degree preferred

Related Experience

Minimum: Two years of experience in a medical office. Basic computer skills required. Other Knowledge, Skills and Abilities

Minimum: Extensive knowledge of insurance market and prior authorization requirements. Ability to organize and prioritize. Ability to manage processes utilizing problem solving and critical thinking skills. Ability to collaborate with clinical care team.

Preferred: Billing and coding knowledge/experience. Knowledge of medical terminology and medical office procedures. Computer Competency Familiarity with standard desktop and windows-based computer system, including email, e-learning, intranet, and computer navigation. Ability to use other software required to perform essential functions. Experience with using EHR system.

Physical/Mental

Minimum: Sitting for extended periods of time. Extensive computer work. Frequent standing, walking. Occasional bending stooping, twisting. Ability to hear speech, speak, use near-far vision and fine motor skills. Ability to perform continuously detailed tasks with frequent interruptions and work prioritization.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran