Referral Coordinator

PeaceHealth; Springfield (OR); On-site; USD 35,000 - 48,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement plan 403b

Paid time off

Life and disability insurance

Education reimbursement

Wellness program

Job summary

PeaceHealth in Oregon is seeking a full-time Referral Coordinator to manage referrals, obtain pre-authorizations, and support the care episode with accurate documentation and cost containment in collaboration with the care team.

The role requires at least 3 years of experience in medical insurance, proficiency with MS Office, and familiarity with Horizon Home Care. You will handle correspondence with patients, physicians, and payors while ensuring records meet guidelines and standards.

Qualifications

• Minimum of 3 years experience in insurance within a medical-related field or similar.
• Proficient with MS Office applications.
• Proficient with Horizon Home Care.

Responsibilities

• Oversee data entry and completion of referral forms; obtain pre-authorization and reauthorization as needed.
• Communicate with patients, physicians, and payors to ensure coverage and accurate referral documentation.
• Maintain and file referral and related documentation in the patient record per guidelines.
• Perform other duties as assigned.

Skills

Insurance requirements

MS Office

Horizon Home Care

Education

Business or two years college

Medical Assistant / LPN / RN preferred

Job description

Description

PeaceHealth is seeking a Referral Coordinator for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is $25.62 – $34.58. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Assure that the services that are approved by private payors have been done and that we request more visits for patients as we continue through the episode of care. May also be responsible for management of referrals; working closely with team members to ensure optimum utilization and cost containment. Provides clerical support and assistance to staff.

Essential Functions

• Oversees the data entry and completion of referral forms/notifications. Obtains insurance pre-authorization for patients and reauthorization of additional treatment. Ensures insurance carrier (including Medicare) documentation requirements are me and referral support documentation is filed in patient’s medical record.
• Efficiently manages correspondence with patients, physicians, specialists, insurance companies. Documents pertinent information on referral form and/or in medical record. Ensures practitioners are following standardized guidelines as recommended by evidenced based medicine.
• Communicates with billing staff and third-party payors to assure coverage of patient care.
• Performs other duties as assigned.

Qualifications

Education

• Accredited School Preferred: Business or two years college And
• Preferred: Medical Assistant, Licensed Practical nurse, or Registered Nurse

Experience

• Minimum of 3 years Required: Experience working in insurance in a medical related field, or other related experience

Credentials

• Preferred: National Certified Medical Assistant or
• Preferred: Licensed Practical Nurse - Oregon or
• Preferred: Registered Nurse

Skills

• Demonstrated experience in insurance requirements for referrals and /or prior authorizations to various therapies (PT, RT, OT, ST), surgeries, procedures, diagnostic testing, and infusions. GYN procedures, testing, etc (Required)
• Proficient with MS Office applications (Required)
• Proficient with Horizon Home Care (Required)

Working Conditions

Lifting

• Consistently operates computer and other office equipment.
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
• Sedentary work.

Environmental Conditions

• Predominantly operates in an office environment.

Mental/Visual

• Ability to communicate and exchange accurate information.
• The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.

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