Referral Specialist II

Processing patient referrals in a timely manner and responding to general information inquiries
Answering a high volume of incoming telephone calls from patients, insurance companies and other healthcare providers;
Ensuring ICD-10 and CPT codes are accurate on referral authorizations prior to submitting them to the insurance company.
Responding to information requests from various parties;
Ensuring referral requests are processed and documented completely and in a timely manner
Obtaining prior authorization from insurance carriers and following up to ensure referral appointments are kept by patients;
Working cooperatively with insurance companies, patients, center and administrative staff;
Case coordinating for chronic diseases and preventive care for patients
Coordinate new intake appointments for referred clients
Meet with potential enrollees and complete necessary documents
Screen new client documentation to ensure completion and accuracy
Enter information into Electronic Medical Record (EHR)
Complete attestations in AVAILITY as needed
Assist in documenting, completing forms and billing for all case coordinating services with providers and assisting Billing Manager
Reaching out to patients who are non-compliant with quality indicators and CPT2 category non-compliant patients and scheduling patient visit or attesting to indicators in AVAILITY or MCO databases
Creating non-compliant quality indicators and CIGNA reports for case coordinators/referral specialist, so they can reach out to those patients
Completing monthly referral audit of all referral specialists and reporting to PCMH manager
Assist with follow up care coordination and PCMH outreach for care coordinators
Training new hires in both referrals and care coordination
Pulling weekly reports and adding to designated worksheet in Excel

Assist with I2i reporting and
Assist with PCMH department huddles