Remote
Job Summary:
The Referral Coordinator is responsible for managing all aspects of the referral process, including responding to internal and external referral requests, documenting all actions, and communicating appointment scheduling, prior authorization approval, benefits, and collections information using the Practice Management system. This role ensures accurate and timely coordination between medical entities, patients, and internal departments.
Essential Duties/Responsibilities:
- Appointment and Authorization Management: Obtain necessary appointments, authorization, prior approval, and benefit information from relevant entities for assigned tasks.
- Documentation: Record all obtained information, including demographic, insurance, and medical records, into the Practice Management system with accuracy and timeliness.
- Information Exchange: Provide required paperwork, such as demographic information, insurance details, and medical records, to medical entities as necessary.
- Patient Communication: Clearly communicate with patients regarding appointment details, authorizations, benefits, and any necessary collections information.
- Phone Communication: Answer all incoming calls routed to the designated number, take messages, and order charts when necessary. Relay messages in a timely and efficient manner, while refraining from triaging calls.
- Coordination with Suite of Origin: Collaborate with the originating suite (medical practice or department) to relay all relevant information, ensuring smooth and clear communication.
- Collaborative Follow-up: Work closely with the Central Business Office to follow up on claims and ensure all information is appropriately documented and processed for billing and collections.
- Meeting Attendance: Participate in team, staff and clinical department meetings and other relevant meetings as required by department managers.
HIPAA, Security, and Privacy Requirements:
- HIPAA Compliance
- Ensure all Protected Health Information (PHI) is handled in accordance with the Health Insurance Portability and Accountability Act (HIPAA).
- Maintain confidentiality of patient records, medical history, billing information, and other sensitive data.
- Access, use, and share PHI only as necessary for billing and claims processing purposes.
- Data Security
- Follow organizational security protocols to safeguard electronic and paper-based patient information.
- Ensure secure storage and transmission of PHI, including the use of encrypted systems or platforms approved by the organization.
- Adhere to password management policies, two-factor authentication, and other security measures to protect access to the Practice Management and billing systems.
- Privacy Protection
- Maintain a strict “need to know” basis for accessing patient information.
- Follow procedures to minimize unauthorized access to patient records, whether physically (in-office) or digitally (online systems).
- Promptly report any security breaches or unauthorized access incidents to the appropriate department or compliance officer.
- Documentation and Auditing
- Accurately document all actions involving patient information to ensure a clear audit trail, including billing, claims processing, and collections activities.
- Participate in regular audits and reviews of billing practices to verify compliance with HIPAA and security regulations.
- Training and Continuing Education
- Complete required HIPAA and security training as mandated by the organization.
- Stay updated on changes in healthcare privacy laws, HIPAA regulations, and organizational policies regarding patient data security.
- Incident Reporting
- Recognize and report any potential privacy or security violations, including unauthorized access to PHI, data breaches, or suspicious activities, following the organization’s incident reporting procedures.
Other Duties:
- Other duties as assigned.
Qualifications:
- High School Diploma or equivalent (required)
Required:
- Strong communication skills, both verbal and written.
- Proficient in using Practice Management software systems.
- Ability to work in a fast-paced environment while maintaining attention to detail.
- Collaborative team player with a focus on customer service.
Preferred:
- Experience in medical office administration, referrals, or related field
