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.