Referral Coordinator

Optum; Farmington (CT); Hybrid; USD 51,577,000 - 91,693,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentive programs

Equity stock purchase

401k plan

Job summary

ProHealth Physicians, part of the Optum family, seeks an Administrative Referral Specialist to coordinate patient referrals between clinicians and insurers, and to handle registration, eligibility checks, and prior authorizations.

This hybrid role in Farmington CT offers telecommuting flexibility; a high school diploma, 1+ year in healthcare settings, MS Office familiarity, and medical coding knowledge are required; EPIC experience preferred.

Qualifications

• High School Diploma or GED.
• 1+ year experience in hospital/clinic settings.
• 6+ months experience in healthcare insurance procedures.
• Proficient with MS Office (Outlook, Word, Excel, PowerPoint).
• Knowledge of ICD-10 and CPT coding.
• Knowledge of medical terminology.
• Must be 18 years or older.

Responsibilities

• Track, coordinate and communicate patient referrals.
• Collaborate with practices for patient registration and insurance.
• Assemble patient clinical background in EPIC.
• Contact insurance for verification of benefits and prior authorization.
• Collaborate with Practice Manager for peer-to-peer/authorization.
• Inform patient of urgent referral details when applicable.
• Coordinate with social workers for financial or access barriers.
• Ensure timely referrals meeting urgency metrics.
• Remind patients of scheduled appointments.
• Ensure patient information/registration is complete.
• Communicate referral/authorization updates to practices.
• Perform other duties as assigned.

Skills

Customer service

MS Office

Medical terminology

Medical coding

Communication

Interpersonal skills

Education

High School Diploma/GED

Tools

EPIC

Job description

Opportunities with ProHealth Physicians, part of the Optum family of businesses. When you work at ProHealth Physicians, your contributions directly sustain the health and well-being of our community. Discover high levels of teamwork, robust medical resources and a deep commitment to exceptional care and service. Join a leading community-based medical group and discover the meaning behind Caring. Connecting. Growing together.

Serves as a liaison between healthcare clinicians and insurances to ensure required referrals have been processed correctly for medical specialty visits and imaging. Performs a wide range of administrative duties to include referral processing, patient registration, verification of benefits, insurance authorizations, patient appointment scheduling, communication with practices and other tasks assigned.

If you are in Farmington, CT, you will have the flexibility to work from home and office-based* in this role as you take on some tough challenges.

Primary Responsibilities:

• Responsible for the tracking, coordination and communication of patient referrals in work queue
• Collaborate with Practices to ensure complete and accurate patient registration, including demographics and current insurance
• Assembles information concerning patient's clinical background in EPIC to help with referral
• Contacts insurance companies to ensure verification of benefits and prior authorization approval requirements are met via web or telephone
• Collaborate with Practice Manager to get Clinician to perform a peer-to-peer for approval/prior authorization for a referral
• Reviews details and expectation of referral with the patient (if it's an urgent request)
• Collaborate with social workers if patients have potential issues related to financial or social barriers (e.g., request interpreters as appropriate, transportation services, etc.)
• Ensures that referrals are addressed in a timely manner and meeting metric goals for urgent vs. non-urgent referrals
• Collaborating with Practice to remind patients of scheduled appointments
• Communication with practices to ensure patient information/ registration is complete
• Communicates referral/prior authorization updates with patient's practice
• Other duties as assigned

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma/GED
• 1+ years of experience working in a hospital, physician's office or medical clinic setting (customer service, patient care, billing/accounting, patient records)
• 6+ months experience in Healthcare Insurance Procedures - commercial, healthcare, State
• Intermediate level of proficiency in MS Office (Outlook, Word, Excel, Power Point)
• Intermediate level of knowledge of Medical Coding - ICD-10 Codes, CPT Codes
• Intermediate level of knowledge of medical terminology
• Must be 18 years old of age OR older

Preferred Qualifications:

• Experience using EPIC
• Clerical or administrative support background

Telecommuting Requirements:

• Reside within commutable distance of 3 Farm Glen Blvd, Farmington, CT
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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