Referral Coordinator

Encompass Medical Group; Lenexa (KS); On-site; USD 32,000 - 46,000; Full time

Job summary

Encompass Medical Group in Lenexa, KS seeks an Administrative Coordinator for pre-certification and referrals. You will manage pre-authorization, verify insurance, gather medical information, and coordinate with physicians, receptionists, and billing to keep patient flow efficient.

You will interact professionally, assist with social barriers, arrange interpreters if needed, and ensure timely referrals while maintaining patient records and communication with insurers.

Qualifications

• High School Graduate or equivalent; medical terminology
• Previous receptionist or customer service skills required
• Previous working experience in a medical setting environment required
• Previous referral coordination experience preferred, but not required
• Knowledge of medical field terminology preferred, but not required
• Any equivalent combination of experience and training which provides the required knowledge, skills and abilities

Responsibilities

• Follow up on specialty/provider summaries not sent to the office within identified standards
• Ensure complete and accurate registration, including patient demographics and current insurance information
• Assemble information concerning patients' clinical background and referral needs
• Contact insurance companies to ensure prior approval requirements are met
• Present necessary medical history, diagnosis and prognosis
• Provide information to financial services to maximize reimbursement
• Review details and expectations regarding referral with patients
• Assist patients with problem solving related to healthcare system, financial or social barriers
• Be the point of contact for patients with questions and concerns
• Advocate on the patient’s behalf with carriers for timely approvals
• Identify and utilize cultural and community resources
• Maintain relationships with service providers
• Ensure referrals are addressed timely per processes
• Remind patients of scheduled appointments
• Update primary care charts with consults, hospitalizations, ER visits
• Coordinate care with outside consultants
• Maintain Basic Cardiac Life Support certification preferred but not required
• Assist in other areas as assigned
• Work with physicians to ensure documentation for referrals
• Verify patient insurance information to determine responsibility
• Assist patients with social determinants needs
• If credentialed, perform transition of care communications
• Care management activities including pre-visit planning and care-gap based orders
• Patient outreach based on care gaps
• Assist with incoming calls and scheduling
• Monitor uncompleted orders and referrals to ensure patient compliance

Skills

Administrative support

Communication skills

Medical office terminology

Education

High School Diploma

Medical terminology knowledge

Job description

Position Summary:

This position is responsible for all aspects of pre-certification, pre-authorization, and any and all other specialty referrals for patients, as well as for organizing and prioritizing daily workflow in order to maintain efficient patient flow throughout the office. Must be able to interact with physicians, receptionists and ancillary services in a courteous and professional manner.

Position Accountabilities:

• Follow up on any specialty/provider which has not sent summaries/reports to office within the identified standard
• Ensure complete and accurate registration, including patient demographics and current insurance information
• Assemble information concerning patients clinical background and referral needs.
• Contact insurance companies and organizations to ensure prior approval requirements are met
• Present necessary medical information history, diagnosis and prognosis
• Provide specific medical information to financial services to maximize reimbursement to companies/organizations and physicians
• Review details and expectations regarding referral with patients
• Assist patients in problem solving potential issues related to health care system, financial or social barriers (i.e. request interpreters as appropriate, transportation services)
• Point of contact for patients with questions and concerns
• Assume advocate role on patient’s behalf with carrier to ensure approval of necessary supplies/services in a timely fashion
• Identify and utilize cultural and community resources
• Establish and maintain relationships with service providers
• Ensure referrals are addressed in a timely fashion in accordance with organizational processes
• Remind patients of scheduled appointments via phone, voice mail, or mail
• Ensure patient’s primary care chart is updated with information on patient consults, hospitalizations, ER visits, and community organization related to their health care
• Coordinate care with outside consultants for additional patient care
• Obtainment and maintenance of Basic Cardiac Life Support Certification preferred but not required
• Provides assistance in other areas as assigned by the Clinical Coordinator and/or Medical Office Manager
• Performs other duties as assigned
• Works with the physicians in the office to ensure that all necessary documentation is in order to facilitate patient specialty and hospital referrals
• Verifies patient insurance information to determine patient
  responsibility
• Assists patients with social determinant needs, as needed
• If credentialed, performs transition of care communications with patients
• Care management activities to include pre-visit planning, order creation based on care gaps
• Patient outreach based on care gaps
• Assists with general incoming phone calls and scheduling
• Monitors uncompleted orders and referrals to ensure patient compliance

Job Specifications:

• High School Graduate or equivalent; medical terminology
• Previous receptionist or customer service skills required
• Previous working experience in a medical setting environment required
• Previous referral coordination experience preferred, but not required
• Knowledge of medical field terminology preferred, but not required
• Prior office/clerical experience preferred, but not required
• Any equivalent combination of experience and training which provides the required knowledge, skills and abilities

Skills – Administrative

• Excellent typing, writing, and spelling skills
• Ability to communicate effectively with office personnel and the public
• Ability to work with minimum of supervision

Working Conditions/Physical Demands

• High volume of keyboard use
• Regular, climate-controlled office environment

Travel may be required to support the necessary coverage for other clinics.