Referral Coordinator

Overview

The Referral Coordinator is responsible for obtaining and coordinating insurance authorizations and pre-certifications for services provided across all assigned OBGYN divisions, providers, and locations. Responsibilities include reviewing schedules and patient information to identify authorization requirements, verifying insurance eligibility and benefits, submitting authorization requests, monitoring requests through completion, and documenting authorization numbers, dates, and determinations accurately in the medical record. The Coordinator works closely with providers, clinical staff, scheduling, and billing teams to resolve authorization issues, prevent delays in patient care, and ensure compliance with payer requirements and organizational policies.

Responsibilities

Insurance Authorizations, Referrals & Eligibility - 70%

• Review patient schedules and obtain required prior authorizations, retro-authorizations, and Global Care Fee authorizations for EVMS Full Care patients.
• Obtain authorizations for obstetrical hospital-based procedures and services, as well as other OBGYN, Maternal Fetal Medicine, diagnostic, and treatment services as deemed necessary by the department.
• Obtain required authorizations and referrals from referring physician offices.
• Verify patient insurance eligibility and identify applicable authorization and referral requirements.
• Monitor authorization requests and follow up as necessary to obtain timely approvals or resolve authorization issues.
• Communicate with patients regarding insurance related requirements, self-pay agreements, and applicable co-payments as appropriate.
• Document authorization approvals and denials, including approved CPT codes and authorization numbers, in the EHR.

EHR, Documentation & Administrative Coordination - 20%

• Complete assigned EHR tasks in accordance with Medical Group standards and departmental requirements.
• Receive and complete assigned tasks from providers and staff in a timely and accurate manner.
• Scan and upload required documents into the appropriate patient charts on a daily basis.
• Maintain accurate, complete, and timely documentation related to authorizations, referrals, insurance verification, and patient accounts.
• Communicate relevant authorization and insurance information to providers, staff, and other appropriate departments to support continuity of patient care and efficient workflow.

Departmental & Operational Support - 10%

• Maintain compliance with policies and procedures of the Department of Obstetrics and Gynecology as well as applicable EVMS Medical Group policies and procedures.
• Collaborate with providers, staff, referring physician offices, patients, and other departments to support efficient departmental operations.
• Perform other duties as assigned in accordance with individual departmental needs and operational priorities.

Qualifications

Minimum Qualifications and Skills:

• Ability to balance multiple priorities and tasks required.

• Professional interaction skills with physicians, outside offices, insurance companies, referring agencies, hospital personnel and support staff required.

• Excellent verbal and written communication skills required.

• Ability to read and comprehend all information required for this position required.

Preferred Qualifications:

• Minimum of two-years’ experience as Medical Receptionist, Patient Account Representative or other relevant role directly handling Medical Insurance information is strongly preferred.

Location : Location