Call & Referral Authorization Coordinator

EvergreenHealth; Kirkland (WA); On-site; USD 29,000 - 45,000; Full time

Benefits offered by this job

Medical, vision and dental insurance

On-demand virtual health care

Life and disability insurance

Retirement plans 457(b) and 401(a)

Job summary

EvergreenHealth is seeking a Referral Coordinator to streamline patient referrals between primary care providers and specialists, interfacing with health plans and case management teams. The role emphasizes accurate coding (ICD-9/CPT) and timely communication within the scheduling call center.

Daily duties include coordinating information for managed care referrals, ensuring compliance with guidelines, and supporting patients, physicians, and hospital staff with confidential handling of records

Qualifications

• Associate’s degree or an equivalent combination of education and experience.
• 3 years of experience in a healthcare insurance or related medical office setting.
• Working knowledge of ICD9 and CPT codes.
• Ability to be flexible and relate well with others in a professional and pleasant manner.
• Knowledge of medical records confidentiality.
• Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians and hospital staff members.

Responsibilities

• Processes patient referrals from PCP to specialist, working directly with health plans, troubleshooting when necessary.
• Serves as a point person coordinating information regarding managed care referrals for patients, providers, case managers and other Utilization Management staff.
• Assigns proper ICD-9 and CPT code(s) to patient referrals.
• Responsible for communication and dissemination of key managed care contractual information and system processes to patients and staff.
• Performs other duties as assigned.

Skills

Communication skills

Tact and poise

Confidentiality knowledge

Flexible / adaptable

Professional demeanor

Education

Associate degree or equivalent

Job description

Wage Range: $20.50 - $32.80 per hour

Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.

Job Summary

Expedites the administrative requirements for patient referral from a primary care provider (PCP) to specialists or specialty services, dealing directly with health plans. Makes decisions and authorizes risk planning referrals, utilizing department and organizational guidelines. Requires daily interaction with patients, staff, healthcare providers, and insurance companies. All job functions are carried out at EvergreenHealth’s scheduling call center.

Primary Duties

• Processes patient referrals from PCP to specialist, working directly with health plans, troubleshooting when necessary.
• Serves as a point person coordinating information regarding managed care referrals for patients, providers, case managers and other Utilization Management staff.
• Assigns proper ICD-9 and CPT code(s) to patient referrals.
• Responsible for communication and dissemination of key managed care contractual information and system processes to patients and staff.
• Performs other duties as assigned

REQUIRED

• Associate’s degree or equivalent combination of education and experience
• 3 years of experience in a healthcare insurance or related medical office setting
• Working knowledge of ICD9 and CPT codes
• Ability to be flexible and relate well with others in a professional and pleasant manner
• Knowledge of medical records confidentiality
• Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians and hospital staff members

DESIRED

• Medical Terminology, medical billing and computer skills
• Working knowledge of insurances, Medicare, DSHS, Labor and Industries, and other third party insurances

Benefit Information

Choices that care for you and your family

At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.

• Medical, vision and dental insurance
• On-demand virtual health care
• Health Savings Account
• Flexible Spending Account
• Life and disability insurance
• Retirement plans 457(b) and 401(a) with employer contribution)
• Tuition assistance for undergraduate and graduate degrees
• Federal Public Service Loan Forgiveness program
• Paid Time Off/Vacation
• Extended Illness Bank/Sick Leave
• Paid holidays
• Voluntary hospital indemnity insurance
• Voluntary identity theft protection
• Voluntary legal insurance
• Pay in lieu of benefits premium program
• Free parking
• Commuter benefits
• Cafeteria & Gift Shop Discount