Position Description

Serve as a liaison between insurance and health care providers to ensure the timely coordination, and accurate processing, of patient referrals required for medical specialty visits.

Major/Essential Functions

• Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.
• Ensure complete and accurate registration, including patient demographics and current insurance information.
• Assemble information on the patient's clinical background and referral needs. Per referral guidelines, provide the specialist with appropriate clinical information.
• Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, and prognosis. Provide specific medical information to financial services to maximize reimbursement.
• Review details and expectations about the referral with patients.
• Assist patients in problem-solving potential issues related to the health care system and financial or social barriers (e.g., requesting interpreters as appropriate, transportation services, or prescription assistance).
• Serve as the system navigator and primary contact for patients and families, allowing them direct access to ask questions and express concerns. May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies -services for the patient in a timely fashion.
• Identify and utilize cultural and community resources.
• Establish and maintain relationships with identified service providers.
• Remind patients of scheduled appointments via, email, mail, or phone.
• Ensure that patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits, and community organizations related to their health.