Referral Coordinator - Home Health

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

Job summary

PeaceHealth is seeking a Referral Coordinator - Home Health for a Full Time, 1.00 FTE, Day position in Washington. The role involves ensuring referrals are processed, securing insurance pre-authorizations, and coordinating with care teams to optimize episode care and cost containment.

Responsibilities include data entry, documentation, and liaison with patients, physicians, and payors. Requires experience in medical insurance and related policies; MS Office and Horizon Home Care proficiency are

Qualifications

• Experience with insurance requirements for referrals and pre-authorizations
• Proficiency in MS Office and patient documentation
• Knowledge of insurance carrier (Medicare) documentation requirements

Responsibilities

• Oversees data entry and completion of referral forms/notifications
• Obtains insurance pre-authorization for patients and reauthorization of treatment
• Communicates with billing staff and third-party payors to assure coverage
• Performs other duties as assigned

Skills

Insurance knowledge

MS Office

Referral coordination

Documentation

Education

Business (2-year college)

Medical-related nursing/MA RN/LPN

Tools

Horizon Home Care

Job description

Description

PeaceHealth is seeking a Referral Coordinator - Home Health 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.

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
• 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 - 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

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.

EEO Affiant Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.