ALL CANDIDATES MUST HAVE EVIDENCE OF COVID-19 VACCINATION AND CPR CERTIFIED PRIOR TO EMPLOYMENT

The Referral Coordinator is responsible for coordinating, distributing, and following-up on referrals originating from our dental, medical, and behavioral health departments. They must use their interpersonal skills to resolve scheduling and access related issues as well as effectively collaborate with patients, team members, physicians, and other stakeholders to maintain a high level of efficiency and quality of care. Must have strong communication skills, providing patients with appointments, and information about their appointments. Must have strong organization skills to provide operational support to assigned department and uphold the mission, vision, and values of SDAIHC.

Essential Functions

• Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake and notification roles.
• Work with hospitals, clinics, facilities, and the clinical team to manage requests for services from members and/or providers and provide information on available network services.
• Verifies eligibility and benefits for each referral and accurately documents into EHR.
• Processes electronic referrals in queues and generates authorizations.
• Accurately uses EHR for daily documentation of information required for denial letters for patients whose benefits do not cover requested services.
• Interfaces effectively with physicians and medical staff to provide referral process training as needed.
• Provide appropriate triage and care coordination notification cases for non-clinical assessment/intervention.
• Handle resolution/inquiries from members and/or providers.

Education/Experience

• High School Diploma or equivalent; Associate degree, medical assisting, or other clinical degree preferred.

Knowledge/Skills

• Experience working within the health care industry and with health care insurance. Knowledge of and experience with medical terminology and procedural coding required; includes ability to interpret insurance information.
• A clerical or administrative support background
• Knowledge of ICD-9 and CPT codes
• Experience with insurance plans, including Medicare and/or Medicaid, third-party payer practices and guidelines, and pre-certification and referral management for insurance plans.
• Experience working in a metric-driven work environment.
• Must have excellent time management skills, be highly organized, self-motivated.
• Maintain a high level of productivity and confidentiality.
• Strong knowledge of computer-based systems such as Excel, Word, and the Internet with the ability to quickly learn new systems.
• The ability to follow through timely on tasks is essential.
• Strong interpersonal skills to work effectively with people of diverse cultural, educational, economical, and social backgrounds.

Before you apply, please make sure you share SDAIHC’s mission and values. We pride ourselves on keeping these values in mind every day as we execute on goals and plan for the future. We are seeking an individual who share the same mindset and commitment to be patient-centric, focused on execution, encourage innovative ideas, challenge the status quo, and support creativity. As a leader, you will motivate others by maintaining positive, professional attitude, exhibit high level of integrity, reliability and capable of providing exceptional patient services by responding with a sense of urgency, practicality, and accountability.