Referral Coordinator

Location: Atrium Health Navicent The Medical Center - 777 Hemlock St, Macon, GA. Department: 36412 Navicent Health Medical Center - Pulmonology Clinic. Status: Full time. Benefits Eligible: Yes. Hours Per Week: 40. Schedule Details/Additional Information: Monday - Friday 8 AM - 5 PM. Pay Range: $21.85 - $32.80.

Responsibilities

Coordination of the Referral Process; Collects all referrals from medical staff daily and obtains any necessary approvals from attendings; Works in all aspects of the referral process, including processing referrals for patients based on primary care physician orders and follow up specialists service recommended; Generates necessary correspondence or calls to patients, physicians and office staff, managed care organizations or vendors requesting additional information and requirements for referral authorization; Communicates with appropriate Physician, nursing staff and patients regarding follow-up status of referrals; Prepare correspondence, input referral information in the automated system, collects additional medical necessity supporting documentation and provide to appropriate parties for approval; Attend PHO and other vendor meetings as required to discuss changes in processing requirements; Identifies potential problems (i.e., labs, x-rays, procedures, and other physicians) with payment of charges from referral by communication with PHO and other managed care specialists; Reviews all payor requirements by type of service and organizes materials to ensure appropriate referral and that steps are followed to avoid claims denials; Investigates diagnosis codes and medical necessity guidelines to determine if appropriate based on payor guidelines; Discusses any discrepancies with physician for correct coding of referral; Provide correct codes both ICD9 and CPT and explains coverage to ordering physician; Input codes into automated system and discuss any certification requirements with vendor's nurse certification specialist; Monitors approval status and resubmit request as necessary; Identifies need for appeal process with insurance companies and Medicare and initiates process; Participate in education and eligibility problem resolution; Works with attendings and nurses in the education of physician office staff on referral procedures; Acts as a resource to customers and help resolve referrals, claims and eligibility issues; Communication with manager, program director, other health care professionals, and various staff in a positive fashion in order to promote patient satisfaction, quality services delivered and resolution of issues; Verify eligibility of patients including problem resolution with Advocate MSO and various managed care organizations; Identifies and maintains appropriate communication with supervisor involving problems and observations in course of daily operations; Other duties as needed; Establish controls and a tickler system set-up to see if services are obtained; Maintain tracker to ensure patient received the services ordered before termination of the referral; Patient have proper paperwork before going to the referral site; Results are received from the specialist prior to the patient's next appointment; Respond as needed to same day request from patient, if patient urgently needed to see a specialist or forgot paperwork; Assures that referral documentation is filed in the medical record and physician sees clinical results of the referrals based on a tracking system put in place; Collect all faxed or mailed in consultant reports for referred patients; Sort and place in physician mail boxes for review with patient chart; Assure that physician has signed off acknowledging review; File data in patient chart and re-file the record in the medical records file room

Requirements

H.S. diploma or G.E.D.; 3-4 years experience in a managed care organization, hospital or physician's office with 1 year referral experience; Excellent medical terminology comprehension and its effective usage; Completion of 1 Medical Terminology class with certificate of completion; Excellent communications skills; Computer literate; Experience with IDX, Windows and other I.S. systems; Good organizing skills; Good problem-solving skills; Ability to handle difficult calls and maintain professional conduct; Excels as a team player; Flexible with job responsibilities; Ability to work independently; Ability to handle stress and high workload volumes; Ability to communicate denial of services to members and providers; Ability to lift up to 35 pounds without assistance

Nice to have

35 wpm keyboarding preferred

Benefits

Paid Time Off programs; Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability; Flexible Spending Accounts for eligible health care and dependent care expenses; Family benefits such as adoption assistance and paid parental leave; Defined contribution retirement plans with employer match and other financial wellness programs; Educational Assistance Program