Referral Coordinator
On-siteProvidence, Rhode Island, United States
Job Summary
Monitor the electronic health record to receive and process referrals and diagnostic imaging prior authorizations during standard clinical hours. Proactively review incoming requests for completeness and accuracy, interpreting insurance guidelines to identify incomplete referrals before processing. Function as a liaison between insurance companies and the care team, checking pending authorization statuses and escalating unresolved high-risk issues. Assist with administrative duties such as expediting referrals, completing routine forms, and communicating directly with community specialists regarding required testing or records. Maintain strict confidentiality of patient health information in accordance with HIPAA regulations.
Required Qualifications
- Excellent oral and written communication skills and the ability to effectively communicate medical and behavioral health conditions to community specialists.
- Ability to work independently and as part of a health care team.
- Basic knowledge/experience in navigating web based portals.
- Basic knowledge/experience in using Microsoft Office products such as Excel, Word, and Outlook.
- Attention to detail.
- Medical Terminology.
- Proficiency in use of the PCHC electronic health record and scheduling system.
- Ability to develop positive relationships with community specialists and insurance carriers.
- Experience with processing prior authorizations and referrals.
- Knowledge of state and federal health care programs, including Medicaid, Medicare and other public benefits programs.
- Knowledge of HIPAA regulations and ability to maintain strict confidentiality of patient health information at all times.
- Experience working with the under-served and uninsured populations.
- Access to reliable transportation.
- Background check/Life Links access.
- Ability to communicate with people of various diverse backgrounds in a sensitive and compassionate way.
- Minimum of an Associate's Degree and/or completion of a medical training program.
- Prior experience working in an ambulatory care center.
Desired Qualifications
- Proficiency in use of the PCHC electronic health record and scheduling system, preferred.
- Experience with processing prior authorizations and referrals, preferred.
- Knowledge of state and federal health care programs, including Medicaid, Medicare and other public benefits programs, preferred.
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