Healthcare Referral Coordinator

Job Description

We are looking for a Referral Navigator Representative to join our team on a contract basis in Pearland, Texas. In this role, you will provide vital administrative support to the referral navigation department, ensuring seamless coordination of prior authorization requests while working closely with clinical staff. This position requires a keen understanding of medical coverage, insurance protocols, and effective communication to manage and direct authorization inquiries efficiently.

Responsibilities:

• Coordinate with clinical staff to initiate and manage prior authorization requests for utilization reviews.

• Accurately interpret and communicate covered benefits and exclusions to ensure compliance with insurance policies.

• Handle and direct prior authorization status inquiries from internal staff in a timely and meticulous manner.

• Assist in obtaining clinical updates and documentation necessary for authorization approvals.

• Maintain precise and organized data entry records for all referral and authorization processes.

• Utilize medical terminology, CPT codes, and ICD-10 codes to ensure accuracy in documentation and billing practices.

• Collaborate with health plan representatives and payers to resolve authorization-related issues.

• Adhere to industry standards and guidelines, including those for Medicare, HMO, and PPO plans.

• Provide additional administrative support and perform ad hoc tasks as needed to meet departmental goals.• Proven experience in a healthcare administrative or referral coordination role.

• Strong knowledge of medical terminology, CPT codes, and ICD-10 coding.

• Familiarity with insurance protocols, including Medicare, HMO, and PPO plans.

• Proficiency in data entry and experience using software such as Epic.

• Excellent communication skills with the ability to interpret and relay complex information clearly.

• Strong organizational and time management skills to handle multiple tasks effectively.

• Understanding of prior authorization processes and payer requirements.

• Ability to work collaboratively within a team-oriented environment.