Referrals Coordinator

Processes referral orders and/or pre-authorizations. Ensures that insurance eligibility checks have been conducted on all referrals before the patient is seen, either by escalating to the Insurance Verifier, or by directly checking on eligibility. Completes referrals and/or pre-authorization, before the patient is seen, for diagnostic testing, therapy, surgeries, procedures and specialty care according to requirements and patient preference. Provides information to patients regarding their health care plan; interprets and communicates plan policies and procedures to employees, physicians and members (patients). Provides patients with answers to billing and insurance clarification questions; obtains a cost estimate when requested and explains insurance benefit coverage to patient. Notifies physician(s) and patient when referral is denied or if a second opinion or additional info is needed. Updates the patient’s medical record as necessary. Copies/scans documents into correct location within electronic medical record. May interact with referring clinic to ensure successful coordination of patient care. Coordinates appointments and ancillary services. Coordinates patient clinic visits based on authorized referral in accordance with established standards and procedures; gathers and documents insurance eligibility data, conducting routine verifications that can be done quickly during conversation; enters data in patient’s electronic medical record as appropriate. Identifies patients requiring contact to confirm a referral appointment; contacts patient in accordance with established procedures. Contacts and follows up with patients to reschedule a missed/cancelled appointment; documents reason(s) for no-show in accordance with established procedures; notifies management if patient has violated a policy and further action is required. Responds to patient questions regarding routine billing and insurance matters. Provides basic information in response to patient questions on billing and insurance matters; obtains a non-complex cost estimate when requested; refers questions regarding more complex cost estimates/benefits information to Financial Counselor. Coordinates patient instructional/educational activities relevant to the patient’s referral. Works with clinic team, patients and/or employers to ensure that patients receive adequate instructions and information regarding educational opportunities relevant to the patient’s referral; provides information to patients regarding their referral appointment and service for testing, financial policies, registration requirements, etc. Provides patient with pre-visit prep materials; packages materials to correspond with type/nature of patient appointment and sends to patient in a timely manner. Coordinates purchase of materials and/or the rental of medical equipment relevant to the patient’s referral. Follows up with patients when equipment return is due.