Medical Secretary / Referral Coordinator

Day (United States of America)

Medical Secretary / Referral Coordinator

This individual is responsible for leading a team in obtaining referrals and authorizations. The Coordinator will also be expected to complete pre-registration screening, as required by insurance companies along with practice policy for a large multiple provider/location practice.

• High School Diploma or GED equivalent required; Associate's or Bachelor's degree preferred
• Two years of experience in referral and authorization fields required
• Microsoft Office applications knowledge required
• Understanding of medical office operations related to patient registration, referrals, authorization & revenue cycle preferred
• Ensures that all required referrals and or authorizations for patient visits have been obtained.
• Resolves pre-certification and registration concerns prior to a patient's appointment.
• Reviews details and expectations regarding referral and authorization process with patients and/or family.
• Gathers pertinent information from insurance carriers and staff to determine patient responsibility.
• Serves as primary resource on all departmental referral and authorization matters.
• Develops, implements, and monitors departmental progress, resource tools, and report findings on a regular basis.
• Communicates with management and staff regarding insurance carrier contractual and regulatory requirements.
• Demonstrates overall knowledge of authorization, benefits and claims processing for insurance companies and plans both private and government.
• Contact review organizations and insurance companies to ensure prior approval requirements are met.
• Present necessary medical information such as history, diagnosis, and prognosis.
• Researches and corrects invalid or incorrect patient demographic information.
• Coordinate appointments as needed with outside facilities and specialist.
• Assists with logistical and/or clerical problem resolution related to the patient's medical record, authorization and billing issues.
• Follows through with any problems or questions in a timely manner, by understanding and using resources available for problem solving in a diplomatic and tactful manner
• Schedule and supervise staff of ambulatory office referral specialists
• Educates and trains staff on referral management, authorizations, and pre-registration
• Works with leadership to establish and maintain effective policies and procedures for referrals, authorizations, revenue cycle, and co-payment collection for the department
• Contacts patients for updated insurance information, when applicable.
• Prepares reports of daily activity as requested for management.
• Performs financial reviews and calculations based upon information received from the insurance company or plan.
• Participates in meetings reporting statistical referral, authorization, and pre-registration measurements and indicators, and communicating required information.
• Assists management in month end reporting as requested.