Referral Coordinator
About this role
Referral Coordinator
Referral Coordinator
Location: Modesto, California (Fully Onsite)
Role Overview
This position involves analyzing, reviewing, and processing referrals for the authorization of outside medical services. The role requires researching and resolving inquiries from providers, members, and staff regarding specific authorizations. The coordinator will also handle telephone and email communications regarding coverage and eligibility.
Key Responsibilities
- Review, evaluate, and process outside medical service referrals for completeness, accuracy, and timeliness.
- Determine appropriate insurance-based coverages (HMO, Medicare/Medical), service codes, and providers.
- Research referrals from doctors to determine eligibility and obtain required approvals.
- Process claims and understand the revenue cycle and medical billing.
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