Referral Coordinator
3 weeks ago
Referral Coordinator plays a key role as part of the clinician team. The RC is responsible for assuring continuity of care for those patients with a referral order, by coordinating timely specialty referral process. The referral process is a multistep process and the Referral Coordinator will work as a liaison between the PCP, Insurance carriers, specialty providers, and patient(s). The RC is responsible for data entry of referral information and documentation of all referral interventions.
BENEFITS
- Free Medical, Dental & Vision
- 13 Paid Holidays + PTO
- 403 (B) retirement match
- Life Insurance, EAP
- Tuition Reimbursement
- SEIU Union
- Flexible Spending Account
- Continued workforce development & training
- Succession plans & growth within
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education & Experience
- Associates Degree or equivalent to 5+ years in the healthcare setting
- Bi-lingual English/Spanish
- Proficient Microsoft office and Excel
- Medical Terminology
- EHR- Electronic Health Records
- Strong customer service focus
- Effective verbal and written communication skills
- Teamwork orientation
- Organized and able to manage competing priorities
- Good judgment
- Resourcefulness in problem solving
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Performs a combination, but not necessarily all, of the following duties:
- Provides oversight of all referral/authorization, of case management and outpatient clinical care coordination functions.
- Manage and assign unassigned referrals to the appropriate Referral Coordinators and evaluate the effectiveness of RCs workload to ensure referrals are processed timely.
- Ensures compliance with regulatory requirements and application of clinical decision support criteria for care management activities deemed by Federal, State and other regulatory and accreditation agencies.
- Assemble information concerning patient’s clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
- Review details and expectations about the referral with patients.
- Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
- Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.
- Ensure PCP timely receives the specialty report and is scanned in the patient’s medical records.
- Access patient medical records and verifies eligibility via Medi-cal/Medicare, Health Plans web portals.
- Authorization-meets productivity referrals processing of an average of 50+ referrals daily including a minimum of 50+ follow up actions.
- Records- requests an average of 95 specialty reports daily.
- Uses Med Point, OPTUM, eConsult and LANES web portals for submitting authorizations.
- Modifies CPT/ICD-10 Codes and extends authorizations as needed.
- Process Urgent referrals within 24 hours of date ordered.
- Process routine referrals within 24-72 hours from date ordered.
- Upload specialist report in EMR within 24 hours from date received.
- Checks Referral Helpline telephone encounters and emails daily.
- Handle high volume of incoming /outgoing calls and provides excellent customer service.
- Seeks assistance of Supervisor when unable to process all referrals or follow-up’s to avoid backlog and the clinical consequences of delays.
- Notifies Supervisor when tasks are completed before end of business day to assist other team members if help is needed.
- Will attend meetings and training at collaborative and partnership events as in person as needed.
- Serve as clinic liaison to outside agencies and partners.
- Uses medical terminology on regular basis for doctors and vendors.
- Interacts with entities (IPA, Health Plans etc.) Medical Management staff including Medical Directors and St John’s Heath services Network, Clinic Manager and other staff.
- Acts as a Provider educator to assure that the Provider is aware of referral timeframes and communicates referral information to patient regarding his/her condition and patient is educated.
- Performs all other related duties assigned.
- Able to cope in a “fast pace” work setting.
- Train new staff and providers as needed.
- Assist with patient complaints.
- Reassign eConsults to appropriate providers.
- Required to work one Saturday per month or as needed.
- Assist the Referral Call Center as needed.
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