Referral Coordinator

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Job Type

Part-time

Description

Under the supervision of the Directors of Patient Services and the Referral Supervisor, the Referral Coordinator is responsible for the processing of insurance referrals, professional communication with both internal and external clients, the registration and documentation of patients at check in as needed, and the provision of excellent customer service.

Representative Duties :

1. Accurately set up referrals for all patients and send to specialists in a timely manner

• Respond to requests regarding authorization for services
• Consult with PCPs to make decisions when specialists are unavailable
• Prepare authorizations using insurance company websites or calls to managed care companies
• Obtain, distribute and document referral authorization numbers
• Input referral numbers into CPS and monitor cancellations, expirations and changes to referrals
• Track services provided to managed care patients off-hours and in emergency
• Schedule radiology and specialist appointments when instructed by a PCP

2. Educate patients, providers, and staff on the various managed care programs

3. Monitor and update managed care member listings and verify membership eligibility

• Update specialty provider offices regarding changing insurance company requirements
• Meet with insurance company representatives to learn updates or pertinent referral information

4. Research problems related to billing services for primary care

• Proactively process referrals for specialists working at FH sites
• Assist patients and patient services staff in calling insurance companies to change PCPs to FH or obtain referrals from outside providers to FH PCPs.

Inform patients that they will face a financial obligation if they fail to change their PCP with their insurance company to a FH provider, or obtain a referral to FH

5. Referral tracking

• Assign referral a tracking modifier
• Request clinical notes from specialist office after patient's visit
• Obtain clinical notes via fax and Careweb
• Locate the tracking referral and complete the referral process

6. Accurately performs registration process for new and existing patients

• Accurately register new patient demographic data in CPS
• Obtain patient insurance data, completed and signed documentation (IIF) and copy of insurance card entering information into CPS accurately
• Ask each patient at check in to verify existing demographic information and insurance information
• Collect co-payments and agreed fees at check-in Accurately record the payment and issue a receipt to the patient
• Be encouraging and sensitive in informing all uninsured or underinsured patients that a meeting with the Financial Assistance Advisor is available to them

7. Schedules appointments according to the patient's needs and provider availability

8. Make Reminder calls to patients as needed

9. Adheres to Patent Registration policies and procedures

• Become familiar with and follow credit and collection policies and procedures as they pertain to patient services functions
• Follow confidentiality guidelines at all times

10. Accurately balance grids and cash drawers

• Verify that all transactions recorded for the week equal the amount documented on the grid
• Report any discrepancies to the Director of Patient Services

11. Participates in quality assessment and improvement activities as requested

12. Provide excellent customer service

• Greet each client with a smile and a welcoming, professional manner
• Answer each phone call in a cheerful and professional manner
• Give patients clear directions to the relevant waiting area and clear instructions to wait there to be called
• Provide clients with correct and accurate information regarding FH services and providers
• Ask for input from team colleagues if unsure of correct response to inquiries
• Refer unusual or difficult situations to supervisor
• Investigate managed care inquiries with PCPs, patients, specialty offices and insurance companies
• Actively build good working relationships with colleagues and providers

13. Perform other related duties as requested

Requirements

• Minimum of high school graduate or equivalent
• Familiarity with state and commercial insurance
• Computer experience required, especially with electronic medical record software, billing / registration software, and Microsoft Office
• Able to meet deadlines, follow through on assigned tasks, and attend carefully to details
• Able to proactively reach out to team members to offer or receive help, ask or answer questions
• Successful customer service background required
• Willingness to work with diverse patient population including the GLBTQ community, seniors, students and others
• Calm, patient and understanding manner
• A willingness to accept changes and challenges
• Ability to work harmoniously and effectively with colleagues, patients, clients and vendors across the spectrum of diversity, including but not limited to race, ethnicity, color, gender identity, sexual orientation, age, socio-economic status, national origin and immigrant status, religious or spiritual identity, disability (physical, mental, emotional and developmental), veteran status, and / or limited English proficiency.
• Willingness to contribute towards Fenway's efforts in becoming an anti-racist organization and promoting a culture dedicated to ongoing development in service of humility, equity, diversity, inclusion, and belonging, where differences are acknowledged and valued.

Preferred Qualifications

• BA / BS
• Knowledge of US healthcare delivery and managed care requirements
• Bilingual Spanish / English preferred
• Experience working in an ethnically, culturally, and racially diverse environment

Ability to meet the following physical requirements with or without reasonable accommodations :

• Sit at a computer station for extended periods of time
• Ability to keyboard for extended periods of time

We offer competitive salaries, and for those who qualify, an excellent benefits package; including comprehensive medical and dental insurance plans, and a retirement plan with employer match.

We also provide 12 paid holidays, paid vacation, and more.

LGBTQIA+ identified persons, Black, Indigenous, and other people of color (BIPOC), and individuals from other historically underrepresented communities are strongly encouraged to apply

Salary Description

$22.62 - 24.87 / hour ($44,109 - $48,496.50 / year)