Referral Coordinator

Employment Type:

Full time

Shift:

Day Shift

Description:

This is a full-time position on day shift.

POSITION PURPOSE

The Referral Coordinator plays a vital role in managing patient care coordination within our network and will be both the welcoming agent ensuring positive patient interaction and the insurance verifier obtaining benefit information and processing provider to provider referrals and authorizations. This critical juncture of the patient interaction relies on the Referral Coordinator’s sound judgment resulting in reduced rework and waste in the staffing models at the office and other organizational departments. The role is the organization's cornerstone to our "One-touch" initiative and our patient satisfaction plans. The Referral Coordinator will be an active participant in process improvement to reflect the organization's constant desire to improve its care delivery processes and systems.

Under limited supervision, the Referral Coordinator is responsible for consistent decision making while performing patient access processes including but not limited to scheduling, registration, insurance verification, referral and authorization processing. Interacts with patient and physician office staff to schedule all future services across a wide scope of clinical departments, including the coordination of multiple services in proper sequence for patients, as well as informing patient/doctor's offices of test preparations, insurance requirements, authorizations and financial responsibility for each service. Collaborates with multiple departments to best utilize resources, while accommodating physician preferences and patient needs. Speaks directly with multiple departments and locations to resolve numerous scheduling and insurance matters including STAT appointments and approvals, block times and appropriate selection of studies to schedule, as well as processing of necessary HMO/PPO insurance referral authorizations. Verifies the patient’s insurance and source of payment and determines the coordination of benefits for scheduled services, as well as prevailing regulatory and 3rd party requirements.

ESSENTIAL FUNCTIONS

• Utilizes Epic Referral WQs to handle out-bound and receive in-bound calls for appointment scheduling following department metrics and satisfying all requirements of scheduling and referral processing workflows.
• Utilizes Availity and payer websites to processes necessary HMO/PPO insurance referrals/authorizations for provider-to-provider visits and added services like injections, x-rays, etc, for internal, incoming, and external referral orders.
• Completes referral workflow with authorization in Epic to close the loop for the patient experience and prevent denials.
• Encourages patient to schedule ordered services within the network, promoting ease of information sharing amongst necessary clinical teams and continuity of care.
• Interviews patients and gathers information to assure appropriate pathway selection which will include but not be limited to accurate and timely scheduling, registration, insurance verification and claims submission.
• Schedules outpatient diagnostic procedures.
• Interprets information collected to determine and create comprehensive patient and visit specific medical and billing records.
• Provides information to patients concerning hospital policies and regulatory requirements utilizing effective interpersonal and guest-relations skills while integrating the organization's "Never Say No" initiative.
• Schedules STAT appointments and obtains department approval for expedited access.
• Schedules services utilizing web enabled system applications, FileMaker, with consideration physician schedule preferences.
• Assists with training of new employees and cross training of other team members.
• Reviews, analyzes, and corrects registration entries to ensure accurate scheduling and registration, and verifies insurance and billing requirements are met prior to services being rendered.
• Verifies insurance coverage at the time of scheduling using Real Time Eligibility system tool for all scheduled services to facilitate accurate assignment of financial responsibility and claims submission.
• Identifies opportunities to improve the quality of scheduling, registration and/or verification processes.
• Responds to patient questions concerning their scheduled services, registration, insurance eligibility and payment requirements as related to their scheduled services.
• Demonstrates accountability to follow-up with patients concerning requests for information of action regarding their appointment and/or account.
• Demonstrates team-player abilities and seamless service to patients.
• Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution.
• Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to Holy Cross Health. Discusses patient and hospital information only among appropriate personnel in appropriately private places.
• Behaves in accordance with the Mission, Vision, and Values of Holy Cross Health.
• Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
• Other duties as assigned.

MINIMUM QUALIFICATIONS

Minimum of 1 year experience in medical office setting preferred.

High school diploma or equivalent is required.

Knowledge of CPT and ICD10 codes and healthcare insurance preferred.

Medical scheduling experience and extensive customer service background is required.

Experience with call center technology is highly desirable.

Must demonstrate critical thinking and sound judgement under high paced stressful environment.

Must possess the ability to comply with Trinity Health policies and procedures.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

REQUIRED SKILLS AND ABILITIES

• Demonstrated computerized system application experience.
• Critical thinking and problem-solving skills.
• Analytical ability to effectively and efficiently resolve registration, scheduling and insurance/authorization issues.
• Exceptional interpersonal communication skills to effectively communicate with patients, team members, clinical colleagues, medical staff, external agencies and contacts.
• Exceptional customer services skills and positive personality attributes.
• Patience in dealing with ordinary, arduous or emotional patients.
• Use of telephones and call center technology.

WORKING CONDITIONS

• Hybrid or fully remote available once fully trained and on-boarded.

Position Highlights and Benefits:

• Comprehensive benefit packages available, including medical, dental, vision, paid time off, 403B, and education assistance.
• Comprehensive benefits that start on your first day of work
• Retirement savings program with employer matching
• We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.
• We live and breathe our guiding behaviors: we support each other in serving, we communicate openly, honestly, respectfully, and directly, we are fully present, we are all accountable, we trust and assume goodness in intentions, and we are continuous learners.

Ministry/Facility Information:

• A member of Trinity Health, one of the largest multi-institutional Catholic health care delivery systems in the nation, Fort Lauderdale-based Holy Cross Hospital, dba Holy Cross Health, is a full-service, not-for-profit, Catholic, teaching hospital operating in the spirit of the Sisters of Mercy.
• We are the only not-for-profit Catholic hospital in Broward and Palm Beach counties.
• Through strategic collaborations and a commitment to being a person-centered, transforming, healing presence, the 557-bed hospital offers progressive inpatient, outpatient and community outreach services and clinical research trials to serve as our community’s trusted health partner for life. We are committed to providing compassionate and holistic person-centered care.

Legal Info:

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.