Referral Coordinator Resume Samples

Description :

1. Responsible for the documentation and implementation relating to all outgoing and internal referrals.
2. Monitor all assigned work queues and processes to ensure that referrals and authorizations are responded to in a timely manner.
3. Confirm the contracted status of requested specialist or provide alternative suggestions if the requested specialist is not contracted with the patient's insurance plan.
4. Review referrals for basic elements and refer to appropriate staff if applicable.
5. Receive all pertinent referral information and forward requests to the insurance plan through different electronic mediums (fax, web-based applications, telephone, etc.) as indicated.
6. Served as a resource to the PRCS providers and staff in regard to referral requirements for contracted insurance carriers.
7. Skills Used Compile and record pertinent medical charts, reports, and correspondence, using secure online database(s) as well as requesting appropriate patient records.

Experience

2-5 Years

Level

Executive

Education

Diploma

Description :

1. Received daily referral request assignments to initiate processing of injured workers medical care needs associated with their case.
2. Obtained necessary pre-authorizations and pre-certs from insurance companies per protocol when applicable.
3. Followed all special instructions and limitations for exclusive insurance clients.
4. Made contact with the injured workers to verify case information and to begin interview for pre-screening questions pertaining to history and verification of type of appointment being scheduled.
5. Scheduled a variety of appointments including Physical Therapy, CT, MRI, Pain Management and follow up appointments.
6. Answered inbound calls in a ACD environment from claimants, adjusters, nurse case manager s for referral initiations and claimant return phone calls from messages left to call to schedule Followed up on medical reports return for designated exams.
7. Reviewed medical reports to ensure all quality standards were met.
8. Forwarded medical reports to all necessary parties including adjusters, nurse case managers and referring doctors.

Experience

7-10 Years

Level

Management

Education

General Education

Description :

1. Verify and update patients insurance, eligibility and benefits using NAVICURE, insurance websites, and with insurance companies via telephone.
2. Practice exceptional organization skills by prioritizing work load to be most productive and efficient Utilize communication skills by following up with patients, insurance coordinators, billing coordinators, physicians, and physician assistants with documentation in EMR and email.
3. Scan and file referrals, authorizations, benefits investigations in EMR within a timely matter.
4. Schedule specialty drug deliveries for patients through approved pharmacies from patient insurance policies.
5. Request and generate paper referrals and authorizations using ICD-9 and CPT codes for procedures and office visits.
6. Counsel patients and advise co-workers of insurance coverage and authorized procedures.
7. Refer patients to charity foundations to continue with treatment that the patients insurance does not cover at 100%.
8. Maintain a steady work flow with high volume calls and patients.

Experience

2-5 Years

Level

Junior

Education

Bachelor Of Science

Description :

1. Responded to requests for protected health information, processed referrals, prior authorizations, and track status.
2. Support and assist physicians with benefit interpretations and health insurance guidelines.
3. Respond courteously to patients, insurance companies and other staff with accurate information.
4. Fax and electronically mail all appropriate medical information and document the released information within patients EMR.
5. Communicate and collaborate with surrounding and out of area medical providers, hospitals, and State affiliations.
6. Assigned to 8 physicians in a Medical Clinic setting, assisted with requests from various medical and specialist providers to process referrals for specialized treatments, and procedures.
7. Communicated with various commercial and state insurances to inquire about coverage of patients and authorize visits and treatments.

Experience

5-7 Years

Level

Executive

Education

Business Office

Description :

1. Responsible for coordinating the entire authorization and scheduling processes for diagnostic and specialist referrals for patients as a result of employer-related injuries.
2. Verified worker compensation insurance and claim details.
3. Worked closely with insurance adjustors and Urgent Care Centers regarding patient diagnoses/prognosis to obtain authorization for follow-up treatment care.
4. Provided case communication updates to employers and R/N Case Managers regarding patient care and progress (communication maintained via; telephone and through email; Outlook).
5. Utilized confidentiality when maintaining patient files (followed HIPPA guidelines).
6. Logged notations in the computer database following all interactions pertaining to patient referrals.
7. Scheduled routine appointments as needed with Concentra Urgent Care Centers and other contracted medical centers/private physicians.
8. Trained new hires and seasoned team members on policies and procedures as needed.

Experience

5-7 Years

Level

Executive

Education

Health Management

Description :

1. Responsible for taking, processing, and scheduling referrals from MD's, hospital, and nursing home discharge planners, and public.
2. Verifies patient demographics, including insurance coverage and admission visit coordination Enters information in the Hospice EMR, updates referral status, and follows up on pending referrals.
3. Assists marketing staff with contacting physicians, hospital discharge planners, nursing home staff, or designated customers of HOC to ensure education of HOC services and programs.
4. Positively communicates with HOC staff and referral contacts and follows proper channels for problem identification and resolution.
5. Takes all switchboard calls from admitted patients, caregivers, HOC staff, and bereavement assistance requests.
6. Reconciles four HOC IPU bed availability and coordinates transport time for acute/respite patients.
7. Responsible for scanning pertinent documents into the EMR upon admission.
8. Maintains and updates bereavement mailing list.

Experience

7-10 Years

Level

Consultant

Education

BSN

Description :

1. Contacted organizations and insurance companies to ensure prior approval requirements were met.
2. Presented necessary medical information such as history, diagnosis, and prognosis.
3. Provided specific medical information Accomplishments Scheduled, problem solved, communicated, and coordinated referral appointments with outside specialists.
4. Maintained accurate records of external referral patient's appointments that are kept, failed, and current status in the Referral Tracking System Faxed referral form to providers with any require records to be sent.
5. Routinely made reminder phone calls, and sent reminder letters by US mail.
6. Responded to In-house provider questions, requests, and concerns regarding the status of patient referrals, or follow-up status.
7. Answered, responded, and documented phone calls, requests, and questions in a timely manner.

Experience

7-10 Years

Level

Management

Education

Medical

Description :

1. Maintained ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.
2. Ensured complete and accurate registration, including patent demographic and current insurance information.
3. Assembled information concerning patient's clinical background and referral needs per referral guidelines.
4. Contacted organizations and insurance companies to ensure prior approval requirements are met.
5. Presented necessary medical information such as history, diagnosis and prognosis to designated providers per predetermination.
6. Provided specific medical information to financial services to maximize reimbursement to the hospital and physicians.
7. Provided accurate procedural and ICD9 codes to the insurance companies for the proper submission of claims.
8. Assisted patients in problem solving potential issues related to the health care system, financial or social barriers.

Experience

5-7 Years

Level

Executive

Education

Medical Coding

Description :

1. Maintained front office operations for alignment with company objectives to streamline the flow and enhance patient satisfaction.
2. Developed, improved and actively managed relationships with primary care physician's offices to strengthen the referral process.
3. Interpreted physician's orders to ensure all tests were scheduled properly.
4. Created, audited and coded all patient accounts to insure accuracy and facilitate appropriate billing.
5. Managed patient registration to ensure accurate demographic and insurance information is collected and entered into the patient record.
6. Established an accounts receivables system to aggressively collected funds do to the practice.
7. Rescheduled appointments to accommodate changes in doctors' schedules Maximized reimbursements.

Experience

5-7 Years

Level

Executive

Education

Bachelors Of Science

Description :

1. Prepared referrals and submitted for processing daily.
2. Scheduled patient diagnostic testing, specialist visits and followed-up with test sites and specialists for patient results.
3. Worked closely with Case Manager to ensure proper tests, procedures and information provided to and acquired from specialists was current and accurate per physician orders.
4. Back-up to Front Desk: check-in, check-out, directing visitors, answering phones, directing calls and taking patient prescription refill requests.
5. Maintained ongoing tracking and appropriate documentation on referrals to ensure patient safety and care.
6. Provided an open line of communication with patients regarding scheduling, preparation for and attendance to appointments.
7. Identified and utilized community resources and established and maintained relationships with identified service providers to better serve patient needs.

Experience

10+ Years

Level

Senior

Education

A.A.S.

Description :

1. Ensure all referrals are complete, accurate and processed in a timely manner which will include the faxing or mailing of referral request and necessary paperwork.
2. Schedule appointments and verify that the patient receive the care the primary care provider has requested.
3. Act as a liaison between the primary care provider, patients, specialists, and health plans.
4. Follow-up with patients, including reminding them of referral appointments.
5. Notifying primary care provider if patient does not follow through with referral appointment.
6. Maintain an environment conducive to patient comfort and confidentiality.
7. Provide clerical support for the clinic, including: providing patients with financial assistance and other resource information, paperwork, documentation in medical record.
8. Provide information and respond to patient inquiries in person, by mail and phone.

Experience

7-10 Years

Level

Management

Education

Bachelor Of Science

Description :

1. Excellent verbal and interpersonal communication skills with employers and in- surance companies to achieve positive impact on outcome cost and quality care.
2. Experienced with Microsoft office products.
3. Experienced working with insurance groups, physicians and medical facilities in making corrections to patient data.
4. Strong analytical and problem-solving skills in locating proper facilities and physicians to assist with patient care.
5. Experienced in performing multiple functional tasks.
6. Experienced in ensuring patient registration data and insurance verification data match before scheduling and billing happens.
7. Proven ability to escalate and work escalations within a stated time period, while adhering to data protection principles.
8. Responsible for ensuring data, processes and procedure changes are updated and communicated to the proper groups.

Experience

2-5 Years

Level

Executive

Education

B. S. In Computer Science