Insurance Referral Specialist

We’re unique. You should be, too.

We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Care Coordinator is a highly visible customer service and patient-focused role. They work directly with the organization’s patient population and their families to authorize, schedule, and ensure completion of patient visits with specialty care. This includes working with insurance representatives and outside vendors, arranging transportation, communicating with physicians, clinicians and other medical personnel, and any other entities necessary for successful completion of approved referrals.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Serve as primary point of contact for incoming and outgoing patient referrals. Triage referrals, gather necessary information, ensure timely processing and assignment to appropriate providers.

• Facilitates communication, collaboration, and coordination of care. Coordinating appointments, referrals, transitions of care between primary care, specialists, hospitals, and other healthcare settings, ensuring seamless transitions and continuity of care.

• Schedules patients utilizing coordinated provider list (CPL), makes all necessary arrangements related to the appointment, notify patients of appointment information: date, time, and location.

• Uses web-based insurance platforms to generate referral authorizations.

• Effectively communicates the physicians/clinicians needs or outstanding items to patients.

• Follows all referrals through to completed appointment and obtains all documentation related to appointment, uploading into organization’s medical record system for physician review prior to PCP follow-up appointment. 

• Ensures any missed external appointments are rescheduled and communicated to the PCP.

• Addresses referral-related phone calls from patients, providers, etc. Completes and addresses phone messages in a timely manner.

• Provides extraordinary customer service to all internal and external customers.

• Performs other related duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of medical terminology, CPT, HCPCS and ICD coding desired

• An understanding of the company's patient population, including the complexities of Medicare programs

• Exceptional organizational skills with the ability to effectively prioritize and complete tasks in a timely manner.

• An understanding of the company's patient population, including the complexities of Medicare programs

• Detail-oriented with the ability to multi-task.

• Able to exercise proper phone etiquette.

• Ability to navigate proficiently through computer software systems & use technology.

• Ability to work well with patients, colleagues, physicians and other personnel in a professional manner.

• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, database, and presentation software.

• Spoken and written fluency in English; bilingual preferred.

EDUCATION AND EXPERIENCE CRITERIA:

• High School diploma or equivalent required

• A minimum of 1 year of referral experience in a healthcare setting required.

• Experience with web-based insurance sites and obtaining referrals/authorizations for multiple payors preferred.

• Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred

• Healthcare experience within the Medicare Advantage population preferred.

• Medical Assistant certification preferred

• CPR for Healthcare Providers is preferred