Referral Coordinator

Sanitas Medical Centers; Surprise (AZ); On-site; USD 38,000 - 52,000; Full time

Job summary

Sanitas Medical Centers in Surprise, AZ is seeking a Referral Coordinator to manage the referral workflow, ensuring patients receive appropriate care by following guidelines, obtaining prior authorizations when needed, processing referrals, and scheduling specialist appointments.

The role requires collaborating with referring providers, verifying insurance, maintaining accurate records in the electronic system, and educating patients about the referral process while protecting privacy under

Qualifications

• Training and Education: staying updated on healthcare regulations and insurance requirements; provide training to staff as needed.
• Assessment and Evaluation: reviewing patient records and assessments; assessing requirements of the patient condition.
• Communication and Liaison: collaborating with referring healthcare providers; communicating with specialists or service providers.
• Insurance Verification and Authorization: verifying insurance coverage for referral services; obtaining pre-authorization from insurers.
• Documentation and Record Keeping: maintaining accurate referral records; entering and updating referral data in the electronic system; documenting reasons, dates, and specialist information.
• Patient Education and Support: explaining the referral process to patients and what to expect.
• Problem-Solving and Issue Resolution: resolving challenges during the referral process.
• Compliance and Privacy: ensuring the referral process complies with HIPAA and privacy policies.

Responsibilities

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Training and Education: Staying updated on healthcare regulations, insurance requirements. Providing training and education to other staff members as needed.
• Assessment and Evaluation: Reviewing patient records and assessments. Assessing the specific requirements of the patient's condition.
• Communication and Liaison: Collaborating with referring healthcare providers. Communicating with specialists or service providers.
• Insurance Verification and Authorization: Verifying patient insurance coverage for the referral services. Obtaining necessary pre-authorization or precertification from insurance providers.
• Documentation and Record Keeping: Maintaining accurate and organized records of all referrals, including relevant details. Must enter and update referral data in the electronic system as appropriate. Documenting the reasons for the referral, dates, and specialist information.
• Patient Education and Support: Explaining the referral process to patients, including reasons for the referral and what to expect.
• Problem-Solving and Issue Resolution: Resolving any challenges or obstacles that may arise during the referral process.
• Compliance and Privacy: Ensuring the referral process complies with healthcare regulations and privacy policies, such as HIPAA.

Job description

“Sanitas is a global healthcare organization expanding across the United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for our patients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of our patients and their families creating a memorable experience through compassion, respect, and kindness.”

Job Summary

The purpose of the Referral Coordinator position is to manage and facilitate the process of referring patients to other healthcare providers or services, ensuring that patients receive the appropriate care and services they need. This includes responsibilities such as following referral procedure guidelines, obtaining prior authorization as needed by health plans, processing referrals, and scheduling appointments to specialists for patients per provider requests. Referral Coordinators play a crucial role in maintaining the continuity of care within the healthcare system.

Essential Job Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Training and Education: Staying updated on healthcare regulations, insurance requirements. Providing training and education to other staff members as needed.
• Assessment and Evaluation: Reviewing patient records and assessments. Assessing the specific requirements of the patient's condition.
• Communication and Liaison: Collaborating with referring healthcare providers. Communicating with specialists or service providers.
• Insurance Verification and Authorization: Verifying patient insurance coverage for the referral services. Obtaining necessary pre-authorization or precertification from insurance providers.
• Documentation and Record Keeping: Maintaining accurate and organized records of all referrals, including relevant details. Must enter and update referral data in the electronic system as appropriate. Documenting the reasons for the referral, dates, and specialist information.
• Patient Education and Support: Explaining the referral process to patients, including reasons for the referral and what to expect.
• Problem-Solving and Issue Resolution: Resolving any challenges or obstacles that may arise during the referral process.
• Compliance and Privacy: Ensuring the referral process complies with healthcare regulations and privacy policies, such as HIPAA.