Lead, Referrals

Schedule - Shift - Hours Full Time - Days

PRIMARY FUNCTION

Trains and supervises Referral Staff.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned.

• Coordinate coverage for referral staff as needed.
• Provide support and training for new referral coordinators.
• Keep abreast of insurance updates and requirements.
• Disseminate new information to staff when needed.
• Resolve referral concerns from patients and managers.
• Help develop, update, and implement referral procedures when needed.

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

OTHER PHYSICAL REQUIREMENTS

• Vision
• Sense of sound
• Sense of touch
• Working in a professional office environment.
• The position involves high & frequent call volumes.
• Environment requires ability to multi-task, communicate clearly & concise, data entry for extended period of times.
• Will require sitting for long periods of time.

TYPICAL WORKING CONDITIONS

• May rotate working in the office and remote/telework.

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of medical terminology, grammar, spelling and punctuation to type correspondence.
• Knowledge of insurance industry.
• Skills in operating a computer, fax, and photocopy machine.
• Ability to read understand and follow oral and written instruction.
• Ability to sort and file materials correctly by alphabetic or numeric systems.
• Ability to speak clearly and concisely.
• Ability to establish and maintain effective working relationships with patients, employees, and the public.
• Typing ability of 40 w.p.m.

EXPERIENCE

• One year as a referral coordinator preferred.
• Word processing and computer experience.

SUPERVISORY RESPONSIBILITIES

Provide support and training for new referral coordinators.

QUALIFICATIONS

EDUCATION

• High school diploma or equivalent.
• Requests for referrals will be initiated by physicians and/or staff and forwarded to the referral coordinator for processing.
• Obtain proper documentation required by insurance companies to have referral authorized; including clinical notes, lab results, consult notes.
• Obtain authorization from the insurance company using insurance websites and written authorization forms as required by insurance companies.
• Data entry of information into computer system.
• Logging of data and follow up with parent and specialist.
• Daily contact with insurance companies, specialists, hospitals, and parents.
• Update processes as changes are dictated by plans and referral supervisor.
• Cover other offices when the coordinator is on vacation.

The Pediatric Associates Family of Companies an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.