Job Description

Referral Coordinator
Providence, RI
16.95/hr

Hours: 

  • Monday, Wednesday, and Friday 8:00am- 5:00pm
  • Tuesday and Thursday 11:00am- 8:00pm or 12:00pm- 8:00pm

Responsibilities:

  • Monitors the electronic health record to receive and process requests for referrals and diagnostic imaging prior authorizations
  • 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
  • Understands 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
  • Ability to navigate, read and interpret the patient’s electronic medical record for diagnoses, CPT/ICD-10 codes, orders, labs, and imaging (MRIs, CT Scans, Ultrasounds, X-rays, etc.)
  • Works indirectly with patients to facilitate appointments with community specialists. Contacts patients by telephone when necessary to assist with making specialty appointments
  • Knowledge of local community specialists, insurance requirements and how to refer a patient to those specialists
  • Expectation for a Referral Coordinator is to process 25r referrals and prior-authorizations during a standard shift

Qualifications:

  • Medical Terminology required
  • Experience with processing prior authorizations and referrals
  • Knowledge of state and federal health care programs, including Medicaid and Medicare
  • Knowledge of HIPAA regulations and ability to maintain confidentiality of patient health information Experience working with the under-served and uninsured populations

Application Instructions

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