About Job

Job Summary
The Referral Coordinator plays a crucial role in managing patient referrals within a healthcare setting. This position requires a detail-oriented individual who can effectively communicate with patients, healthcare providers, and insurance companies to ensure seamless referral processes. The ideal candidate will possess a solid understanding of medical terminology, coding, and managed care systems to facilitate accurate and timely referrals.

Coordinates provider referrals, pre-certifications, and pre-authorizations for managed care insurance plans.

PRIMARY RESPONSIBILITIES

Attends in-services provided by various health plans.
Travels to off-site locations as necessary.
Gathers necessary clinical information and processes referrals, pre-certification, pre-determinations, and pre-authorizes according to insurance plan requirements.
Logs, tracks and reviews managed care approvals and denials.
Responds in a timely manner to last minute/emergency referrals or additional codes performed during a procedure, or procedural changes for pre-authorizations.
Verifies insurance coverage, benefits and creates price estimates, reverifications as needed (ex; first of the month reverifications for managed Medicaid's).
Works collaboratively with insurance companies, providers and staff to ensure plan requirements have been met prior to patient services being rendered in order to maximize reimbursement.
Preregisters patients for appointments.
Schedules patients for appointments appropriately.
Performs all other duties as assigned.

**MINIMUM REQUIREMENTS**
EDUCATION