Referral Coordinator I - Patient Access & Authorization

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

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.