Referral Coordinator

• Obtain pre-certifications and pre-authorizations for procedures and specialist referral appointments
• Schedule outpatient testing with other providers for Wayne Health
• Coordinate, document and process medical referrals and prior authorizations requested by clinic providers
• Answer incoming calls from patients and the public
• Schedule appointments for imaging, diagnostic services, and new and returning patients
• Make follow-up phone calls and address complaints
• Troubleshoot problems and provide information to patients and the public
• Process referrals and submit medical records to insurance carriers
• Verify patient insurance eligibility and benefits
• Request, track, follow up on and secure authorizations before services
• Manage referral repositories including EHR buckets, provider email, faxes, Auth inbox and Teams message groups
• Document and communicate patient correspondence and messages in the EMR
• Apply ICD10 and CPT code knowledge
• Achieve productivity and quality metrics
• Review authorization information for accuracy and completeness
• Prioritize authorizations by patient urgency
• Update patient insurance, contact details and demographics in the EHR
• Monitor insurance changes affecting coverage and authorization requirements
• Support appeals for denied authorizations
• Update patient information and registration
• Respond to patient inquiries by phone and email
• Research information using available resources
• Resolve and escalate patient complaints and urgent or emergent questions
• Route calls to appropriate resources
• Follow up with patients and callers within departmental timeframes
• Document communications according to standard operating procedures
• Answer Wayne Health calls and contribute to team operations

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