Referral Coordinator

Job Description

Job Description

A Referral Coordinator works collaboratively with physicians, practitioners, counsellors, nurse case managers and other departments to coordinate transfer of care between PCHC providers and community specialists. This person functions as the problem solver for their clinical team – assisting with administrative duties such as completing and expediting referrals, medication prior authorization from different insurance companies, assisting with completion of routine forms, and other logistical duties.

Duties & Responsibilities :

• Monitors the electronic health record to receive and process requests for referrals and diagnostic imaging prior authorizations during standard clinical hours. Able to prioritize and successfully process referrals and related forms from multiple providers.
• Proactively reviews new referrals and diagnostic imaging prior-authorization requests for completeness and accuracy. Able to interpret standard insurance guidelines to identify incomplete referrals before processing, and communicates directly with the care team regarding any necessary testing or records required for approval.
• Has a clear understanding of insurance plans, with knowledge of covered services and community specialists within the insurance company’s network.
• Functions as a liaison between insurance companies and care teams for high risk referrals and diagnostic imaging requests. Accesses insurance companies web-based program(s) to check the status of pending prior authorizations. Escalates all unresolved high risk referral issues back to the care team in a timely manner.

Qualifications :

Education :

PCHC is EOE / M / F / D / V / SO