Referral Coordinator - Orthopedics

PeaceHealth; Ketchikan (AK); On-site; USD 37,000 - 51,000; Full time

Benefits offered by this job

Medical/dental/vision coverage

403b retirement plan employer base and

Paid time off

Life and disability insurance

Tuition and continuing education

Wellness benefits

Job summary

PeaceHealth Ketchikan and/or Prince of Wales is seeking a Referral Coordinator - Orthopedics for a Full Time, 1.00 FTE, Day position. The role ensures referrals are properly processed, pre-authorizations obtained, and patient records maintained.

Excellent MS Office and Horizon Home Care proficiency is required; experience with insurance and medical billing will support cost containment and efficient care episodes.

Qualifications

• Minimum of 3 years experience working in insurance in a medical-related field.
• Accredited School Preferred: Business or two years college.
• Preferred: Medical Assistant, Licensed Practical Nurse, or Registered Nurse.

Responsibilities

• Oversees data entry and completion of referral forms/notifications; obtains insurance pre-authorization and reauthorization; ensures documentation is filed in the medical record.
• Manages correspondence with patients, physicians, and insurance companies; documents information in referrals/records; ensures providers follow guidelines.
• Coordinates with billing staff and third-party payors to assure coverage of patient care.
• Performs other duties as assigned.

Skills

Insurance referrals/authorizations

MS Office

Horizon Home Care

Communication with payors

Education

Business or two years college

LPN/LPN license or RN license

Tools

MS Office

Horizon Home Care

Job description

Description

PeaceHealth Ketchikan and/or Prince of Wales is seeking a Referral Coordinator - Orthopedics for a Full Time, 1.00 FTE, Day position.

The salary range for this job opening at PeaceHealth is $27.16 - $36.66.

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
• 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)

Department / Location Specific Notes

Ketchikan Medical Center:

• Experience/Training: Minimum of two years' experience working in insurance in a medical related field or other related field.
• Will provide administrative support to RN and Pharmacist in case management.
• Will perform duties of Patient Access Representative

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.

For additional information or questions, please email Jen Worthington at [e-mail] or call 360-448-0542.

We offer caregivers a competitive and comprehensive total rewards package.

• 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.

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