Referral Coordinator I

CareMore Health Management Services, LLC; Henderson (NV); On-site; USD 26,036 - 39,054; Full time

Job summary

Mosaic Health is seeking a Referral Coordinator I to process routing clinical referrals and handle authorization requests following established procedures.

The role involves coordinating with hospitals, health plans, physicians, patients and vendors to ensure timely referral workflows and data accuracy. Prior experience in healthcare administration and medical terminology is preferred.

Qualifications

• High school diploma or GED and minimum of 1 year of customer service or healthcare administrative experience required; or any combination of education and experience which would provide an equivalent background.
• Medical Assistant certificate / certification from an accredited training program required.
• Knowledge of medical terminology, plan specific guidelines; ICD-9 and CPT coding preferred.

Responsibilities

• Initiates and processes routing clinical referrals and authorization requests following established procedures.
• Serves as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources to support referral coordination.
• Reviews referrals for completeness and accuracy and follows up for additional information if necessary.
• Verifies insurance coverage and initiates pre-authorization requests in accordance with payer requirements and established workflows.
• Responds to inbound requests related to referral processing while meeting productivity and quality standards.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enters referrals, documents communications, actions and related information in system.
• Escalates complex referral issues or authorization concerns to senior referral coordinators or leadership as appropriate.

Skills

Customer service

Healthcare administrative experience

Medical terminology

Authorization knowledge

Insurance verification

Education

High school diploma or GED

Medical Assistant certificate

Job description

Job Description Summary The Referral Coordinator I processes routine referrals and supports authorization activities while meeting quality and productivity standards.

How will you make an impact & Requirements

Primary Responsibilities

• Initiates and processes routing clinical referrals and authorization requests following established procedures.
• Serves as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources to support referral coordination.
• Reviews referrals for completeness and accuracy and follows up for additional information if necessary.
• Verifies insurance coverage and initiates pre-authorization requests in accordance with payer requirements and established workflows.
• Responds to inbound requests related to referral processing while meeting productivity and quality standards.
• Contacts physician offices as needed to obtain demographic information or related data.
• Enters referrals, documents communications, actions and related information in system.
• Escalates complex referral issues or authorization concerns to senior referral coordinators or leadership as appropriate.

Minimum Qualifications

• High school diploma or GED and minimum of 1 year of customer service or healthcare administrative experience required; or any combination of education and experience which would provide an equivalent background.
• Medical Assistant certificate / certification from an accredited training program required.
• Knowledge of medical terminology, plan specific guidelines; ICD-9 and CPT coding preferred.

Compensation Range: $18.90 to $28.35 The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

Beware of fraudulent job postings: While Mosaic Health job advertisements may be found on many sites, our current openings page and its associated Workday account are the only places we accept applications for open roles. If you suspect a job post is fraudulent, please let us know at [e-mail].

Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans.

Learn More about Mosaic HealthLearn More about Millennium Physician GroupLearn More about CareMore HealthLearn More about Castlight HealthLearn More about Vera Whole Health