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Referrals Coordinator - Revenue Cycle - Baptist MD Anderson

Date Posted: Apr 15, 2021

Status: Full-Time

Shift Details: Days

Job Summary

We’re hiring for a Revenue Cycle Referrals Coordinator for the TAP Department in Jacksonville, Florida. This is a full-time day position located at Baptist MD Anderson.

The primary purpose of the BMDA referral coordinator is to work directly with patients, physician and physician teams, and insurance companies to obtain authorizations and/or referrals for physician, imaging services, rehabilitation, infusion therapy, radiation oncology, and surgery appointment types for both the physician and facility. This includes adherence to the department’s policies and procedures related to the verification of eligibility/benefits, prior authorization requirements, and other identified financial clearance related duties. Authorizations and referrals must be obtained in a timely manner and status of such must be clearly documented in the relevant systems. The referral coordinator is responsible for timely escalation of financial clearance issues to the supervisor. The BMDA referral coordinator should possess knowledge related to the field of oncology and is tasked with the following responsibilities:
• Obtains and documents all required insurance authorizations for both the professional and institutional facilities with special attention to detail of place of service and applicable effective dates using the available institutional and/or payor systems, including real-time web portals and tools, within the applicable timeframes outlined by the department policies and procedures. Promptly notifies Patient Access, and in some cases the patient, when eligibility information is invalid and/or cannot be verified or if authorization is not able to be obtained in a timely manner.
• Documents updated and/or corrected insurance information into the system in accordance with applicable department policies and procedures.
• Verifies insurance eligibility and medical necessity, documenting any applicable information.
• Timely manage financial clearance task list for cases requiring prior authorization and work directly with the payor or assigned third party vendor to obtain all required prior authorizations. Seek to obtain pre-authorization through online web portals and tools, when available. Accurately document all reference and prior authorization numbers along with payor contact information within the appropriate systems.
• Arrange Peer to Peer reviews between the physician and the physician employed by the insurance carrier in order to facilitate approval for requested service.
• Completely, timely, and accurately document conversations and communications with other departments, payors, third party vendors, patients, and any other representative inside or outside of the institution.
• Answers emails, phone calls, and Cerner messages in a timely and accurately manner as well as respond to voicemails within one business day.
• Conducts all financial clearance activities in a courteous and professional manner and maintains a positive working relationship with patients, physicians, payors, third party vendors, and any other identified business partners.
• Seeks to improve job performance and personal growth by participating in available education, training, and mentoring opportunities.
• Follow department guidelines to reschedule both new and established patient visits, diagnostics, chemotherapy, radiation, rehabilitation, and surgery if no referral/authorization is able to be obtained.
• Process referrals, verifies insurance, and obtains authorizations and/or referrals for Baptist Primary Care offices referring patients to BMDA.
• Perform all other duties as assigned.
The BMDA referral coordinator positively impacts the Baptist MD Anderson patient experience by ensuring all patient insurances are verified and all authorizations are properly obtained prior to the patient visit. The referral coordinator is will be well versed in all payer specific insurance verification and authorization rules for both the institutional and professional facilities. The referral coordinator shall possess up to date knowledge related to the field of oncology, CPT codes, ICD/10 Codes, MUE edits, and Payer edits, Payer Authorization processes as well as any current year changes made by CMS regarding medical necessity guidelines. The referral coordinator must be detail-oriented and possess the knowledge and understanding to read clinical documentation to provide additional information to insurance carriers. The referral coordinator is able to communicate effectively with patients, physicians, insurance carriers, coders, and other team members within BMDA, as effective communication will promote a patient centric experience by ensuring all departments work together to obtain verification and authorization for all services a patient may require throughout their cycle of care. The referral coordinator must be able to work in a fast-paced environment and have the time management, organizational, and multitasking skills necessary to perform a variety of duties concurrently. Team members in this position must consistently demonstrate a positive demeanor, must be self-motivated, have a strong work ethic, and must be a team player.

If you are interested in this Revenue Cyle Referrals Coordinator position at Baptist, please apply now.


Education Required

High School Diploma/GED

Education Preferred

Associate's Degree

Experience

  • Less than 1 year Medical Office Experience

License and Certification

  • None

Location

Baptist MD Anderson Ctr
1235 San Marco Blvd
Jacksonville, Florida, 32207


Location Overview

For more than 20 years, health care consumers have named Baptist Medical Center Jacksonville the "most preferred healthcare provider" in the region. As the central hub of the Baptist Health system, Baptist Jacksonville provides the highest level of medical and surgical care using the latest technologies, such as the robotic-assisted da Vinci™ Surgical System. Centrally located on the beautiful St. Johns River in downtown Jacksonville, Baptist Medical Center Jacksonville is Baptist Health's flagship tertiary-care hospital. Designated as a Magnet hospital by the American Nurses Credentialing Center for excellence in patient care, Baptist Medical Center Jacksonville has repeatedly been named among U.S. News & World Report's "Best Hospitals.” The hospital has also been ranked as high performing in more than 10 specialties from neurology and neurosurgery to gynecology, diabetes, endocrinology,oncology and more.  Baptist Health also has a new Stroke & Cerebrovascular Center, which is a regional epicenter for advanced treatment of strokes, aneurysms and other brain conditions.  As one of 100 Best Places to Work in Healthcare in the U.S. by Modern Healthcare, Baptist Medical Center Jacksonville is located close to sports, theater and music venues, museums, shopping and dining.