Referral Coordinator – Remote in Golden, CO

This position will process multi-practice requests for all services that require referrals and pre-authorization in a manner that ensures timeliness, accuracy, and maximum reimbursement.

This position is full time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm MST. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of training. The hours during training will be 8:00am to 5:00pm MST, Monday – Friday. 

If you are located within commutable distance of 1707 Cole Blvd. Golden, CO, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

 

Primary Responsibilities:

• Receives, reviews, and coordinates all information required to initiate a referral for pre-authorization for health care services for multiple practices.
• Follows protocols set up by New West Physicians and contracted payors. Utilized New West Physicians Practice Guidelines as required.
• Advises providers concerning the adequacy of the information contained in the referral.  Makes suggestions within the protocols of the referral manual.
• Maintains accurate documentation of the referral in the patient’s medical record.
• Maintains a communication log or tracking system for follow-up, data gathering and analysis.
• Communicates to patients and providers in the referral network in a timely manner the status or completion of the referral and any information required to ensure continuity of care to the patient.  Documents communication as required to ensure service excellence.
• Maintains an effective working relationship with the office staff of referral providers, and with the office staff of contracted insurance companies.  Documents communication as required to maintain service excellence.
• Communicates in a timely manner to patient’s primary care physician referrals that are denied or that require more information for approval.
• Demonstrates critical thinking skills and effective communication skills in investigating breakdowns in the referral process to ensure positive working relationships with everyone involved.
• Demonstrates excellent customer service skills:  warm, respectful, gracious, and courteous in all communications.  Notifies practice manager of referral breakdowns and patient complaints.
• Educates patients and staff on changes in the referral process, alternatives available within the insurance plan and consequences of out-of-plan services.
• Maintains knowledge base of service plan benefits, criteria for plan enrollment and eligibility timeframes, and resources available to the patient within the plan for information on plan services.
• Other duties as assigned.
• HIPAA Security Level:  High access to systems/patient information.
• Supervisory Duties:  None.
• Work Environment/Schedule:  Telecommuter, first 90 days probation period training can be done in office of through Microsoft teams. Full time Monday thru Friday 8am -5pm. 

 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age OR older
• 1+ years of hands-on experience in computer data entry and telephone customer service
• Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm MST. It may be necessary, given the business need, to work occasional overtime

 

Preferred Qualifications:

• Previous experience working with insurance portals
• Knowledge of medical terminology

 

Telecommuting Requirements:

• Reside within commutable distance of 1707 Cole Blvd. Golden, CO
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service