Referral Coordinator
AHS Vista LLC
- Waukegan, Illinois, United States
- Waukegan, Illinois, United States
Über
Receive, review, and process incoming and outgoing referrals in compliance with payer and organizational requirements Verify patient insurance eligibility, benefits, coverage limitations, and authorization requirements prior to services being rendered Obtain prior authorizations and referrals from insurance carriers, primary care providers, and specialists as required Accurately document insurance verification details, referral status, authorization numbers, and related communications in the EHR or practice management system Communicate clearly with patients regarding insurance coverage, referral requirements, financial responsibility, and next steps in scheduling care Coordinate with clinical staff, scheduling teams, and external provider offices to ensure referrals are complete and services are scheduled appropriately Contact insurance companies to clarify benefits, resolve discrepancies, appeal authorization or referral denials, and confirm payer policies Monitor referral and authorization turnaround times to minimize delays in patient care Maintain compliance with HIPAA, payer contracts, and organizational policies when handling protected health information (PHI) Identify and escalate insurance coverage issues, referral denials, or incomplete documentation to appropriate leadership or billing teams Support billing and revenue cycle processes by ensuring all referrals and authorizations are complete and accurate prior to claim submission Stay current on changes in insurance plans, referral guidelines, and authorization requirements for common payers Supervision
Performs job duties with minimal supervision Internal & External Relationships Internal Interactions
Demonstrates professionalism, respect, and collaboration with coworkers and management Works collaboratively and provides assistance to team members as needed
External Interactions
Treats patients and customers as a priority in all interactions Communicates effectively and compassionately to address patient questions and concerns Demonstrates respect and sensitivity to diverse cultures, backgrounds, and needs Equipment Used
Standard office equipment including computer, telephone, fax machine, and copier Working Environment & Physical Requirements
Primarily seated work with occasional walking, standing, bending, lifting, and carrying (up to 50 lbs) Visual and hearing acuity required (corrective devices permitted) May be exposed to infectious or contagious diseases May be required to handle emergency or crisis situations Occasional irregular hours, on‑call, or call‑in support may be required May be required to wear personal protective equipment (PPE) as necessary Bloodborne Pathogen Exposure: No exposure Minimum Qualifications Education
High school diploma or equivalent
Experience
Minimum of two (2) years' experience in a hospital or medical‑related environment Working knowledge of medical insurance and the insurance industry required At least one (1) year of customer service experience
Skills & Training
Proficiency with computers and standard office equipment Strong organizational skills, attention to detail, and communication abilities Patient Population Served
All age groups: adolescent, adult, pediatric, and geriatric Travel & On‑Call Requirements
Travel to other Vista Health sites may be required On‑call and call‑in support required as needed to meet departmental or facility staffing needs Licensure / Certification
No licensure or certification required Equal Opportunity Statement & Disclaimer Vista Health System is an equal opportunity employer. This job description is not a contract of employment, and job duties may be modified or expanded based on organizational needs.
Sprachkenntnisse
- English
Hinweis für Nutzer
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