Referral Quality Coordinator

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Evaluate incoming referrals that are processed through AI-driven technologies

• Validate patient demographics, insurance details, provider information, diagnosis specifics, and accompanying clinical documentation

• Cross-check extracted data against original documents to ensure precision

• Categorize referral documentation in accordance with established workflow guidelines

• Detect incomplete, conflicting, duplicate, or erroneous information

• Ensure referrals include the necessary information for authorization and scheduling processes

• Identify absent clinical documentation and payer-specific requirements

• Address routine discrepancies and escalate complex matters as needed

• Collaborate with providers, clinical teams, and internal departments to gather missing information

• Prepare referrals for seamless transition into the authorization workflow

• Utilize independent judgment when assessing AI-generated information

• Maintain high accuracy levels while fulfilling productivity benchmarks

• Adhere to standardized review processes and quality standards

• Recognize ongoing workflow, documentation, or technology challenges

• Contribute to process enhancements and the adoption of innovative technologies

⛳️ Requirements

• High school diploma or equivalent qualification

• 2-3 years of experience in healthcare intake, patient access, prior authorization support, insurance verification, or a similar healthcare operations role

• Experience collaborating with commercial and government payers, including Medicare and Medicaid

• Understanding of medical terminology and clinical documentation

• Familiarity with referral management, insurance verification, and authorization workflows

• Proficient in using EMR, practice management, or healthcare workflow systems

• Skilled in Microsoft Outlook and Excel

• Preferred: Associate degree in Healthcare Administration, Medical Office Management, or a related field

• Preferred: Experience in supporting infusion services, specialty pharmacy, or buy-and-bill environments

• Preferred: Knowledge of payer-specific authorization requirements across commercial and government plans

🏝️ Benefits

• Medical, Dental, and Vision Coverage

• Prescription Drug Coverage and Telemedicine Services

• Health Savings Account (HSA), Health Reimbursement Arrangement (HRA), and Flexible Spending Options

• 401(k) Retirement Plan with Company Match

• Life, AD&D, and Disability Insurance

• Accident, Critical Illness, and Hospital Indemnity Coverage

• Fertility and Family Planning Support

• Tuition Reimbursement and Certification Assistance

• Continuing Education and Professional Development Resources

• Employee Assistance Program and Wellness Support

• Paid Time Off

• Volunteer Time Off and Charitable Giving Match

• Employee Referral Bonus Program