Referral Coordinator

Union-Community-Care; Pennsylvania; On-site; USD 38,000 - 48,000; Full time

Job summary

Union Community Care is seeking a Referral Coordinator to manage prior authorizations and schedule specialty care for patients. You will liaise with patients, specialists’ offices and payers to move referrals through the approval and appointment process.

Ideal candidates have a high school diploma, excellent communication skills, healthcare exposure, and the ability to handle changing insurance requirements while supporting care teams.

Qualifications

• High School diploma or GED required.
• Excellent telephone and customer service skills.
• Healthcare experience required; referrals experience preferred.
• Ability to communicate in English fluently, including reading, speaking and writing.
• Medical terminology knowledge preferred.

Responsibilities

• Coordinate with patients, specialists’ offices and insurance companies to obtain prior authorizations for specialty care or diagnostic tests.
• Coordinate with offices and patients to obtain appointments and submit required documentation to authorize visits with the payer.
• Keep up to date with insurers’ requirements to ensure appropriate coverage for needed specialties.
• Develop good working relationships with specialty offices to facilitate referrals.
• Prioritize referrals based on urgency and communicate progress to providers.
• Follow up and close referral loop per policy.

Skills

Customer service

English fluency

Healthcare experience

Medical terminology

Education

High School diploma or GED

Job description

Our Mission, Vision, & Model of CareAt 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.JOB SUMMARYThe 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 DUTIESCoordinates 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 REQUIREMENTSHigh 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 insurancecompanies, policies, practices and patients.Work collaboratively with the care teams.Ability to communicate in English fluently, including reading, speaking and writingMedical terminologyESSENTIAL FUNCTIONSIn order to fulfill the requirements of this position, duties 1-9 are considered essential functions of the job.ORGANIZATIONAL INVOLVEMENTThis position is required to participate in mandatory all staff meetings, team meetings and trainings.