Referral Coordinator

Union-Community-Care; Lancaster (Lancaster County); On-site; USD 36,000 - 48,000; Full time

Job summary

Union Community Care on Duke Street in Lancaster, PA is seeking a Referral Coordinator to manage prior authorizations and arrange specialty care for patients. You will track referrals, connect patients with resources, and coordinate between care teams and specialists to ensure timely access.

The role requires a High School diploma, excellent phone and customer service skills, and healthcare experience with referrals.

Qualifications

• High School diploma or GED.
• Excellent telephone and customer service skills.
• Healthcare experience required; referrals experience preferred.
• Ability to track frequently changing information from insurers.
• Ability to communicate in English fluently (reading, speaking, writing).
• Medical terminology knowledge.

Responsibilities

• Coordinate with patients, specialists' offices and insurers to obtain prior authorizations.
• Schedule appointments and submit required documentation to authorize visits.
• Keep up to date with insurer requirements for coverage of specialties.
• Understand and follow referral and prioritization protocols for each payer.
• Develop working relationships with specialty offices to facilitate referrals.
• Maintain current lists of specialists, insured payers, required documentation, and scheduling details.
• Prioritize referrals and communicate progress with providers.
• Follow up to close the referral loop per policy.
• Perform other duties as assigned.

Skills

Telephone skills

Customer service

Healthcare experience

Referral coordination

English proficiency

Medical terminology

Education

High School diploma

Job description

Job DetailsJob Location: Duke Street - Lancaster, PA 17602

Our Mission, Vision, & Model of Care

At Union Community Care, our purpose is at the forefront of all that we do: we stand for whole health to help you live your fullest life.

We envision vibrant and healthy communities supported by inclusive healthcare that embraces each member's unique culture, needs, and values, and emboldens them to make healthful choices that fuel their well-being and the well-being of others.

We believe in whole health. This means we address and heal disease but equally important, we work at the causes of the causes, the social ills that must be addressed to achieve true equity.

We listen, learn, and embrace the complex lives and unique strengths of our patients, and we work hard to break down all barriers to care. This means we look through a grassroots lens. We connect with our communities because we are our communities. Each of us is a neighbor, a friend, a family member, and together, we are a trusted community health center.

Qualifications

JOB SUMMARY

The Referral Coordinator is responsible for completing prior authorizations and arranging specialty care appointments for patients. The Referral Coordinators track and follow up on referrals orders per Union policy and connect patients with resources to overcome barriers to completing referrals. The referral coordinators communicate between care teams and specialists assist patients with accessing appointments and complete referral documentation and forms.

SPECIFIC JOB DUTIES

• Coordinates with patients, specialists' offices and insurance companies to efficiently obtain prior authorizations for patients who need specialty care appointments and/or diagnostic tests that require prior authorization.
• Coordinates with offices and patients to obtain appointments for patients and submits required documentation to authorize the visit with the payer.
• Keeps up to date with all the insurance companies' requirements, ensuring that the specific specialties and specialists needed by the patient are covered by the insurance company.
• Understands and follows the protocols for referral and prioritization for each payer.
• Develops a good working relationship with the various specialty offices to facilitate the referrals.
• Maintains current lists of specialist offices, insurances with whom they participate, documentation required, and how to schedule patients with their office.
• Prioritize work in the referrals bucket based on urgency. Communicates regularly with the providers to keep them informed of the progress of the referral through the process.
• Follows up and closes the referral loop per policy.
• Performs all other work-related duties as assigned.

POSITION REQUIREMENTS

• High School diploma or G.E.D.
• Excellent telephone and customer service skills.
• Healthcare experience required; prior referrals experience preferred.
• Ability to keep track of frequently changing information and details of insurance companies, policies, practices and patients.
• Work collaboratively with the care teams.
• Ability to communicate in English fluently, including reading, speaking and writing
• Medical terminology

ESSENTIAL FUNCTIONS

In order to fulfill the requirements of this position, duties 1-9 are considered essential functions of the job.

ORGANIZATIONAL INVOLVEMENT

This position is required to participate in mandatory all staff meetings, team meetings and trainings.