Medical Secretary / Referral Coordinator

About the role

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.

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