Referral Coordinator

Referral Coordinator

Requirements

• Knowledge of medical terminology, CPT, HCPCS and ICD coding desired
• Exceptional organizational skills with the ability to effectively prioritize and complete tasks in a timely manner.
• Detail-oriented with the ability to multi-task.
• Able to exercise proper phone etiquette.
• Ability to navigate proficiently through computer software systems & use technology.
• Ability to work well with patients, colleagues, physicians and other personnel in a professional manner.
• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, database, and presentation software.
• Spoken and written fluency in English; bilingual preferred.

Responsibilities

• Daily review of approved and pended outpatient requests for PMR clients and ChenMed Markets
• Provide insights to the PMR team and Network Director and work with them to take action.
• Facilitate a daily process to help redirect poorly supported requests by providing feedback to Humana, Careplus, Wellcare and Coventry and working through daily authorization requests when information is missing.
• Create process for managing requests when patients need to see the primary care provider by coordinating with primary care provider and Market leaders.
• Enable a member of PMR network or clinical team to reach out to authorization requester when deemed necessary.
• Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible one dependent on market needs.
• Travel as needed to PMR & ChenMed markets for training and support.

Preferred Qualifications

• Experience with web-based insurance sites and obtaining referrals/authorizations for multiple payors preferred.
• Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred.
• Healthcare experience within the Medicare Advantage population preferred.
• Medical Assistant certification preferred.
• CPR for Healthcare Providers is preferred.