Referral Coordinator chez EyeHealth Northwest

Description

Summary

Responsible for verifying and securing authorizations/referrals for patient appointments and authorizations for diagnostic testing and other services. Track referrals and communicate with patients to ensure completion of all referrals/authorizations. Perform work with a focus on effective communication with the patient, coworkers, and the physician. Demonstrate cooperation with coworkers while striving to ensure the highest level of patient care and “customer service,” representing EHN in a professional manner at all times.

Supervisory Responsibilities

This position does not have supervisory responsibility but will provide guidance to employees and/or assist with orientation and training of new employees of the work group.

Primary Duties and Responsibilities

• Obtain authorizations, referrals, or pre-certification for patient’s procedures and/or office visits; verifies insurance eligibilities and benefits.
• Ensures all necessary documentation and preparatory activities have been completed and, if applicable, forwards necessary information to the provider prior to the patient’s appointment.
• Ensure all patient referral information and documentation is thorough, accurate and updated; enter referrals/authorizations into database; ensure proper authorizations are in the patient’s EHR (Electronic Health Record) chart.
• Research referral and provider information as needed; contact appropriate insurance providers for managed care patients and obtain authorization services.
• Contact physicians to obtain referrals as needed.
• Follow up on referral issues; communicate with the patient’s PCP and insurance provider to resolve discrepancies.
• Coordinator work with EHN Bookkeeping Department to ensure patients are appropriately billed.  
• Utilizes a thorough knowledge base on a range of referral-related issues, keeping current on the policies and procedures of various insurance carriers.
• Prepares referral forms for exams, tests, procedures, consults, and specialty appointments.
• Follow up and notify provider whether or not the patient follows through with recommended exams, test, procedures, consults, and specialty appointments in order to close the loop.
• Demonstrate team values through cooperation and consideration of coworkers; foster goodwill among coworker by providing assistance when needed and sharing information that helps others do their jobs; interact with tact, courtesy and diplomacy.
• Effectively communicates with coworkers, doctors, and patients; share information appropriately and complete the communication circle with follow-up as needed; communicate in a positive, upbeat manner while refraining from complaining, gossiping, or engaging in conversations of a negative tone. 
• Protect confidential patient information and use good judgment in sharing patient information in a manner that is consistent with patient care and current laws and regulations, including HIPAA.
• Adhere to all safety standards as established by company policy and OSHA requirements.
• Perform work in compliance with company policy, department procedures and regulatory requirements, including State and Federal laws and regulations.

Secondary Functions

• Other duties which may be necessary or desirable to serve the patient and support the success of the department or the company overall.

Education and/or Experience; Certificates, Licenses, and Registrations (Minimum Requirements)

• High school diploma or equivalent.
• Minimum of 1 year experience preferred.
• An equivalent combination of education, experience and training that would provide the knowledge, skills and abilities required for the successful performance of the essential job duties.

Necessary Knowledge, Skills and Abilities

• Must be computer literate with proficiency in Windows based programs.
• Ability to complete basic mathematic equations.
• Knowledge and understanding of medical terminology and procedures relating to the eye.
• Must be highly organized with the ability to effectively prioritize duties.
• Ability to establish and maintain cooperative working relationships with all persons contacted in the course of performing duties.
• Strong interpersonal skills with a genuine desire to help people.
• Ability to address patient complaints and effectively resolve problems.
• Skill in handling difficult patients successfully and respectfully.
• Ability to communicate clearly and concisely, both orally and in writing.
• Must be detail oriented.
• Ability to work a flexible work schedule, including evenings and weekends, and a willingness to rotate to various worksites as needed.

Physical Demands / Work Environment

• Majority of work is performed in a general office environment. Exposure to moderate levels of noise in a well-lit, well-ventilated and moderately paced environment.
• Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.                
• Manual/finger dexterity as necessary to perform daily job duties.
• Occasionally required to stand and/or walk for extended periods of time.
• Occasionally required to sit for extended periods of time.
• Occasionally required to reach with hands and arms; lift, push, pull and/or carry objects up to 20 pounds.

Reasonable Accommodations

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EHN believes that each employee makes a significant contribution to our overall success.  That contribution should not be limited by assigned responsibilities. This job description is designed to outline primary functions, qualifications, and job scope, but is not intended to limit the employee or EHN to only those job functions identified. EHN expects each employee to offer his or her services wherever and whenever necessary to ensure superior customer service, quality patient care, and the success of our business.

Qualifications

Education and/or Experience; Certificates, Licenses, and Registrations (Minimum Requirements)

• High school diploma or equivalent.
• Minimum of 1 year experience preferred.
• An equivalent combination of education, experience and training that would provide the knowledge, skills and abilities required for the successful performance of the essential job duties.

Necessary Knowledge, Skills and Abilities

• Must be computer literate with proficiency in Windows based programs.
• Ability to complete basic mathematic equations.
• Knowledge and understanding of medical terminology and procedures relating to the eye.
• Must be highly organized with the ability to effectively prioritize duties.
• Ability to establish and maintain cooperative working relationships with all persons contacted in the course of performing duties.
• Strong interpersonal skills with a genuine desire to help people.
• Ability to address patient complaints and effectively resolve problems.
• Skill in handling difficult patients successfully and respectfully.
• Ability to communicate clearly and concisely, both orally and in writing.
• Must be detail oriented.
• Ability to work a flexible work schedule, including evenings and weekends, and a willingness to rotate to various worksites as needed.

Physical Demands / Work Environment

• Majority of work is performed in a general office environment. Exposure to moderate levels of noise in a well-lit, well-ventilated and moderately paced environment.
• Visual acuity adequate to perform job duties, including reading information from printed sources and computer screens.                
• Manual/finger dexterity as necessary to perform daily job duties.
• Occasionally required to stand and/or walk for extended periods of time.
• Occasionally required to sit for extended periods of time.
• Occasionally required to reach with hands and arms; lift, push, pull and/or carry objects up to 20 pounds.

Reasonable Accommodations

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EHN believes that each employee makes a significant contribution to our overall success.  That contribution should not be limited by assigned responsibilities. This job description is designed to outline primary functions, qualifications, and job scope, but is not intended to limit the employee or EHN to only those job functions identified. EHN expects each employee to offer his or her services wherever and whenever necessary to ensure superior customer service, quality patient care, and the success of our business.