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Eligibility and Referral Coordinator

Newport Beach, CA

 

Job Summary:

We are seeking a highly organized and detail-oriented Eligibility and Referral Coordinator to join our dynamic dermatology office team. The Eligibility and Referral Coordinator plays a crucial role in ensuring seamless coordination of patient referrals, promoting effective communication between healthcare providers, and enhancing the overall patient experience.

Essential Functions:

To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation.

  1. Referral Processing:

    • Receive and review referral requests from both internal and external sources.
    • Verify referral information for accuracy and completeness.
    • Ensure all necessary documentation is included in the referral request.

  2. Communication:

    • Collaborate with referring healthcare providers to obtain additional information when needed.
    • Communicate with patients to provide information about the referral process and schedule appointments with specialists.
    • Maintain open lines of communication between our dermatology office and referring healthcare professionals.

  3. Documentation and Record Keeping:

    • Maintain accurate and up-to-date records of all referral activities.
    • Input referral information into the electronic health record (EHR) system.
    • Generate reports on referral status and outcomes for review by management.

  4. Insurance Verification:

    • Verify insurance coverage for referred services and communicate relevant information to patients.
    • Coordinate with the billing and insurance teams to address any pre-authorization requirements.
    • Navigate local IPA/HMO portals such as Optum, Hoag Physician Partners, Availity, and others efficiently.

  5. Appointment Scheduling:

    • Schedule appointments for patients with specialists or for additional diagnostic tests as needed.
    • Ensure that appointments align with both patient and specialist availability.

  6. Follow-Up:

    • Track and manage the status of pending referrals to ensure timely completion.
    • Follow up with patients to confirm receipt of specialist appointments and address any concerns.

  7. Collaboration:

    • Collaborate with other administrative staff, healthcare providers, and specialists to optimize the referral process.
    • Participate in regular meetings to discuss and improve referral workflows.

KNOWLEDGE, SKILLS, & ABILITIES: 

  • High school diploma or equivalent; additional education or certification in healthcare administration is a plus.
  • Previous experience in insurance eligibility verification and prior authorization within a medical setting, preferably in dermatology.
  • Familiarity with medical terminology, insurance processes, and electronic health record systems.
  • Excellent communication skills, both written and verbal.
  • Strong organizational skills and attention to detail.
  • Ability to work independently and collaboratively in a fast-paced healthcare environment.
  • Familiarity and comfort with navigating local IPA/HMO portals, including Optum, Hoag Physician Partners, Availity, etc.

 

PHYSICAL AND MENTAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job responsibilities.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods of time; use hands to finger, handle or fell objects, tools, or controls; reach with hands and arms; climb stairs; balance, stoop, kneel, bend, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift, push, pull and/or move up to 20 pounds. Required specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

PAY AND HOURS:

$18 - $21/hr. Part time, 8 hour days. 

NOTE:  This job description may not include all of the duties assigned to the employee and may be updated and modified by the department supervisor, according to the operations at any given time.

 

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