Referral Coordinator

Poppy Bank; Phoenix (AZ); On-site; USD 38,000 - 52,000; Full time

Job summary

Poppy Bank is seeking a Referral Coordinator to manage referral operations and prior authorization processes within our Phoenix clinics. You will coordinate with patients, physicians, and insurers to streamline appointments and ensure timely authorizations.

The role requires at least two years of experience in pre-authorization or insurance verification, familiarity with major health plans, and strict HIPAA compliance. Proficiency with Windows and Microsoft Office is expected.

Qualifications

• Two years of pre-authorization or insurance verification experience.
• Knowledge of Medicare, Medicaid, HMO, and PPO plans.
• HIPAA compliance and confidentiality.

Responsibilities

• Schedule appointments with patients, physicians, and staff.
• Verify eligibility, coverage criteria, and benefits with insurers.
• Coordinate referrals and complete patient assessments.
• Process and fax medical records to relevant departments.
• Maintain patient charts in ECW and update physician portals.
• Support referral sources and communications with providers.

Skills

Customer service

HIPAA compliance

Communication

Organization

Education

High school

Tools

ECW

Windows

Microsoft Office

Job description

• Location 9520 West Palm Lane,Suite 150-A,Phoenix, AZ, 85037,United States
• Job Category Prior Authorization, Referals, Insurance Verifcation
• Employee Type Full Time-Non-Exempt
• Required Degree High school

Description

• Scheduling appointments with patients, physicians, and other medical staff members and insurance portals.
• Coordinating with insurance companies to verify eligibility, coverage criteria, and benefits.
• Coordinated referrals and completed patient assessments
• Coordinated and provided in-services for referral sources

Requirements

Job Responsibilities & Duties:

• Scheduling appointments with patients, physicians, and other medical staff members and insurance portals.
• Coordinating with insurance companies to verify eligibility, coverage criteria, and benefits.
• Coordinated referrals and completed patient assessments
• Coordinated and provided in-services for referral sources
• Expediting patient referrals to specialty offices
• Completing referral requests as needed
• Faxing and sending medical records to our various departments for processing
• Monitored outside relationships with other facilities and other public relations activities

• Records timely in EHR per the corporation’s policy and procedure in a timely manner
• Obtains clinical information required to request prior authorizations
• Create patient charts in ECW and enter all information
• Generate specialty referrals for members as requested by primary care physicians
• Call to schedule all incoming referrals via fax inbox and physician portals
• Maintain accurate insurances and office information in physician portals
• Consult with other department regarding referral needs, insurance verification and eligibility
• Maintain timely responses to referral requests

These duties are not exclusive and with consideration of the job requirements and employee skills, this job description can be added to or taken away from the discretion of the employee’s immediate supervisor.

• Strong customer service background preferred.
• Minimum of two years’ experience of pre-authorization or insurance verification with demonstrated knowledge of health insurance plans including: Medicare, Medicaid, HMO’s, and PPO's required.

• Educated on and compliant with HIPAA regulations; maintains strict confidentiality or client information.
• Ability to work effectively within role independently and with other team members.
• Ability to organize and complete work in a timely manner.
• Ability to understand medical/surgical terminology.
• Proficiency with Windows, Microsoft Office (Word, Excel, Outlook, PowerPoint, Internet Explorer).
• Ability to receive instructions.

Dress Code:

Black scrubs and closed toe shoes are required for this position or business casual.

Summary

Position Summary: The referral coordinator is responsible for referral operations at assigned clinics, establishing and standardizing systems and procedures for the distribution and use of health information throughout the organization, coordinating and referral functions with all other departments.