Utilization coordinator vs referral coordinator

Differences between utilization coordinator and referral coordinator duties and responsibilities

Utilization coordinator example responsibilities.

• Manage and coordinate authorization of denial letters and request for appeals with all levels of services.
• Manage and coordinate the workload of the release team members and are responsible for organizing and hosting all production release windows.
• Perform accurate verification of eligibility and benefits as well as advanced application of CPT, ICD-9 and ICD-10 codes.
• Assign accurate ICD-9 and CPT codes to request services for referral and authorization processing.
• Claim adjudication for assign HMO members.
• Provide orientation to pre-certification process for HMO, PPO, and POS members.
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Referral coordinator example responsibilities.

• Establish rapport with all PCP offices, hospital personnel, and manage care representatives.
• Ensure CPT and ICD-9 coding are accurate and complete according to AMA's guidelines and for third party intermediaries.
• Contact medical insurance companies and provide ICD-9 diagnosis and CPT procedure codes for patient's illness, condition or injury.
• Apply ICD-9 and CPT-4 codes to complete referral requests online or via fax.
• Conduct the entire office's EHR process and create a system to track old and new patient's records.
• Incorporate core organizational values of quality, respect, integrity, partnership, and compassion in all activities and decisions.
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