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About the Role

As a Referral Coordinator at St. Peter's Health Partner's, you will support a rapidly growing Orthopedics Team. This role offers a unique blend of career advancement opportunities and a focus on quality of life, with office hours Monday-Friday.

Responsibilities

• Maintains and tracks referrals from beginning to end, ensuring accountability for the referral loop.
• Answers, responds to, and documents phone calls, requests, and questions from patients, physicians, ancillary services, or specialty offices in a timely and accurate manner.
• Assembles information concerning a patient’s clinical background and referral needs, providing appropriate documented clinical information to specialists per referral guidelines.
• Reviews details and expectations regarding the referral with patients.
• Communicates prep instructions to patients via documented orders or protocol.
• Receives and reviews referral requests, prioritizing orders based on urgency.
• Schedules, problem-solves, communicates, and coordinates referral appointments with patients, physicians, specialists, and/or central scheduling.
• Collaborates with essential care team members including physicians, mid-level providers, LPN's, MA's, and Practice staff.
• Maintains patient confidentiality and abides by all HIPPA guidelines.
• Obtains necessary authorization for referrals and diagnostic testing in a timely fashion with proper documentation.
• Works in collaboration with Billing Analyst on denied claims for missing prior authorization or referral within the EMR system.
• Maintains up-to-date knowledge of referral/payer prior authorization requirements, eligibility guidelines, and documentation requirements.
• Communicates insurance decisions to patients.
• Conducts follow-up calls as necessary to physician offices, patients, and payers to complete the pre-certification process.
• Confirms payer is in-network with the specialist, contacting the patient to discuss and make alternate arrangements if necessary.
• Acts as the point of contact for all referral-related matters, serving as the expert for assigned office(s).

Requirements

• Minimum of 5 years of experience in a medical office.
• Effective written and verbal communication skills.
• Knowledge of insurance payers and processes.
• Demonstrates attention to detail, organization, and effective time management.
• Ability to work independently with little supervision.
• Knowledge of ICD-10, CPT, and CPTII codes.
• Solid judgment to escalate issues appropriately.
• Advanced knowledge of Microsoft Office, related computer programs, and general office machines.
• Ability to communicate effectively with the patient population while exhibiting exemplary customer service skills.

Skills

• Microsoft Office
• ICD-10
• CPT
• CPTII codes
• Customer Service

Location

• Rensselaer, NY

Work Type

• Full-time
• Hybrid Remote

Experience Level

• 5 years minimum experience in a medical office

Education Level

• High School Diploma or equivalent
• BA preferred

Salary/Compensations

• $19.20 - $25.85 per hour

Benefits

• Strong orientation program
• Generous tuition allowance
• Career development

About the Company

• At St. Peter's Health Partner's, we care for more people in more places.
• Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings.
• By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care.

Equal Opportunity

• All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.