Referral Coordinator

Sanitas Medical Centers; Katy (TX); On-site; USD 40,000 - 60,000; Full time

Job summary

Sanitas Medical Centers is seeking a Referral Coordinator to manage patient referrals, obtain prior authorizations, and schedule specialist appointments. You will ensure continuity of care by coordinating with providers, this role requires attention to regulatory requirements and patient privacy.

The position emphasizes accurate documentation, staff training, and effective communication with patients and health plans to streamline referrals and improve service delivery.

Qualifications

• Experience or familiarity with healthcare regulations and insurance requirements.
• Ability to review patient records and assess referral needs.
• Strong communication with providers, specialists and staff.
• Ability to verify insurance coverage and obtain necessary pre-authorizations.
• Accurate documentation and record keeping in electronic systems.
• Ability to explain referral processes to patients and provide support.
• Problem-solving skills to address referral challenges.
• Commitment to privacy and HIPAA compliance.

Responsibilities

• Train and educate staff on regulations and insurance requirements.
• Review patient records to assess referral needs and conditions.
• Collaborate with referring providers and specialists to coordinate care.
• Verify insurance coverage and obtain required pre-authorizations.
• Maintain accurate referral records and update the electronic system.
• Explain referral steps to patients and set expectations.
• Resolve issues that arise during the referral process.
• Ensure compliance with privacy regulations, including HIPAA.

Skills

Training and Education

Assessment and Evaluation

Communication and Liaison

Insurance Verification

Documentation

Patient Education

Problem-Solving

Compliance

Job description

“Sanitas is a global healthcare organization expanding across the United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for our patients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of our patients and their families creating a memorable experience through compassion, respect, and kindness.”

Job Summary

The purpose of the Referral Coordinator position is to manage and facilitate the process of referring patients to other healthcare providers or services, ensuring that patients receive the appropriate care and services they need. This includes responsibilities such as following referral procedure guidelines, obtaining prior authorization as needed by health plans, processing referrals, and scheduling appointments to specialists for patients per provider requests. Referral Coordinators play a crucial role in maintaining the continuity of care within the healthcare system.

Essential Job Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Training and Education: Staying updated on healthcare regulations, insurance requirements. Providing training and education to other staff members as needed.
• Assessment and Evaluation: Reviewing patient records and assessments. Assessing the specific requirements of the patient's condition.
• Communication and Liaison: Collaborating with referring healthcare providers. Communicating with specialists or service providers.
• Insurance Verification and Authorization: Verifying patient insurance coverage for the referral services. Obtaining necessary pre-authorization or precertification from insurance providers.
• Documentation and Record Keeping: Maintaining accurate and organized records of all referrals, including relevant details. Must enter and update referral data in the electronic system as appropriate. Documenting the reasons for the referral, dates, and specialist information.
• Patient Education and Support: Explaining the referral process to patients, including reasons for the referral and what to expect.
• Problem-Solving and Issue Resolution: Resolving any challenges or obstacles that may arise during the referral process.
• Compliance and Privacy: Ensuring the referral process complies with healthcare regulations and privacy policies, such as HIPAA.