Referral Coordinator at Apex Systems

Job#: 3010159

Job Description:

if you are interested, please send your resume to [email protected] .

Job Summary Under direct supervision, the Referral Coordinator analyzes, reviews, and processes referrals for authorization of outside medical services. This includes handling a defined set of referral types and specialties, following established protocols, and seeking supervisory guidance as needed. The role involves researching and resolving inquiries from providers, members, and staff, updating authorizations in the system, and contributing to process improvements that enhance service levels and operational efficiency.

These positions require lifting/short distance transport up to 20 pounds.

Major Responsibilities & Essential Functions

Referral Processing – 70%

• Review, evaluate, and process outside medical service referrals for completeness, accuracy, and timeliness
• Determine appropriate coverage, service codes, and providers
• Obtain necessary approvals and issue notifications
  
  

Customer Service & Coordination – 15%

• Process referrals for specific procedures and providers per policy
• Conduct report reviews and corrections
• Respond to inquiries from patients, providers, and case managers
• Collaborate with clinical teams to ensure timely and accurate authorizations
• Follow up with referring providers when information is incomplete
  
  

Contract & Claims Support – 15%

• Confirm outside provider agreements and request letters of payment when needed
• Accurately code referrals to reflect special claims handling requirements
  
  

Job Qualifications

Minimum Education:

• Associate’s degree or two (2) years of directly related experience in accounting or a related field
• High School Diploma or GED required
  
  

Preferred Education:

• Bachelor’s degree preferred
  
  

Minimum Experience & Skills:

• Ability to lift and transport up to 20 pounds
• Experience in medical assistance, utilization management, authorization, or coding in a hospital or clinic setting
• Familiarity with health information systems or medical records databases
• Knowledge of medical terminology and coding
• Strong customer service, phone communication, and problem-solving skills
• Ability to prioritize tasks in a high-volume, fast-paced environment
• Must be able to work in a Labor/Management Partnership environment
  
  

Preferred Experience:

• Familiarity with Medicare, Medi-Cal, and KFHP benefits
• Understanding of medical procedures and terminology
  
  

EEO Employer

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or 844-463-6178.

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing in Talent Satisfaction in the United States and Great Place to Work in the United Kingdom and Mexico.

Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Apex team member can provide.

Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing in Talent Satisfaction in the United States and Great Place to Work in the United Kingdom and Mexico.

Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our ‘Welcome Packet’ as well, which an Apex team member can provide.

Apex Systems is part of the Commercial Segment of ASGN Incorporated.

NYSE: ASGN

4400 Cox Road

Suite 200

Glen Allen, Virginia 23060

Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] (Do not submit resumes or solicit consultants to this email address). UnitedHealthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Apex Systems.