PeaceHealth is seeking a Referral Coordinator - Quality & Coordination for a Full Time, Day position. Hourly compensation starts at $17.61, more depending on experience.
Assure that the services that are approved by private payors have been done and that we request more visits for patients as we continue through the episode of care. May also be responsible for management of referrals; working closely with team members to ensure optimum utilization and cost containment. Provides clerical support and assistance to staff.
- Oversees the data entry and completion of referral forms/notifications. Obtains insurance pre-authorization for patients and reauthorization of additional treatment. Ensures insurance carrier (including Medicare) documentation requirements are met and referral support documentation is filed in patient’s medical record.
- Efficiently manages correspondence with patients, physicians, specialists, insurance companies. Documents pertinent information on referral form and/or in medical record. Ensures practitioners are following standardized guidelines as recommended by evidenced based medicine.
- Communicates with billing staff and third party payors to assure coverage of patient care.
- Performs other duties as assigned.
- Two years college or accredited business school preferred.
- Medical Assistant, Licensed Practical nurse, or Registered Nurse highly desired.
- 3 years experience working in insurance in a medical related field, or other related experience
- Demonstrated experience in insurance requirements for referrals and /or prior authorizations to various therapies (PT, RT, OT, ST), surgeries, procedures, diagnostic testing, ophthalmic exams, GYN procedures, testing, etc.
- Proficient with MS Office applications
- Proficient with Horizon Home Care
REGION/LOCATION SPECIFIC NOTES
PHMG -PHYSICAL/COGNITIVE REQUIREMENTS:
- Work requires fairly light physical exertion from 34 to 65% of the time.
- Ability to lift objects weighing 30 lbs. or less.
- Work is performed under normal working conditions with adequate lighting and ventilation.
- Job duties frequently require intense concentration and attention to detail (34-65% of work time).
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For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.