Referral Coordinator - General Surgery

PeaceHealth; Vancouver (WA); On-site; USD 35,000 - 48,000; Full time

Job summary

PeaceHealth is seeking a Referral Coordinator - General Surgery for a Full Time, 1.00 FTE, Day position. The role ensures referrals are processed, pre-authorizations obtained, and documentation filed in the patient’s chart.

Provides clerical support to the staff and aids in coordinating care within the episode of care. The position emphasizes collaboration with team members to optimize utilization, manage referrals, and support cost containment while maintaining compliance with insurance

Qualifications

• Minimum of 3 years experience in insurance in a medical-related field or related experience.
• Proficient with MS Office applications and Horizon Home Care.
• Accredited School Preferred: Business or two years college; Healthcare credentials preferred.

Responsibilities

• Oversees data entry and completion of referral forms/notifications.
• Obtains insurance pre-authorization and reauthorization of treatment.
• Communicates with patients, physicians, insurers, and billing staff to ensure coverage.
• Ensures documentation is filed in the patient record and supports cost containment.

Skills

Insurance requirements

MS Office

Horizon Home Care

Education

Business or two years college

Medical personnel qualification (MA/LPN/RN)

Job description

Description

PeaceHealth is seeking a Referral Coordinator - General Surgery 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.

Job Summary

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.

Details of the Position

• 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.

What you bring

• Accredited School Preferred: Business or two years college And
• Preferred: Medical Assistant, Licensed Practical nurse, or Registered Nurse
• Minimum of 3 years Required: Experience working in insurance in a medical related field, or other related experience
• Preferred: National Certified Medical Assistant or
• Preferred: Licensed Practical Nurse - Oregon or
• Preferred: Licensed Practical Nurse - Alaska or
• Preferred: Licensed Practical Nurse - Washington 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

• 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.
• Predominantly operates in an office environment.
• 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.

For full consideration of your skills and abilities, EEO.