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Referral Coordinator

2 months ago

Orange, California, United States Prospect Medical Holdings Full time

Job Summary

The Referral Coordinator - Healthcare Specialist will play a critical role in ensuring seamless referral management processes for Prospect Medical Holdings. This individual will be responsible for preparing referrals, addressing stat line requests, and completing daily tasks/queues as assigned.

Key Responsibilities

  • Process referral requests received and assigned referral queue using Auto Approval List.
  • Pend nurse and Medical Director review to appropriate referral requests timely to ensure compliance is maintained.
  • Complete daily referral assignments received by fax, phone, or portal, etc.
  • Document pertinent information in IDX to include medical notes, benefit information, contracted vs non-contracted provider.
  • Accurate data entry into IDX fields.
  • Maintain timeliness standards by regulatory requirement for each product line.
  • Maintain daily production standard based on corresponding assigned job duties set by department manager.
  • Handle stat calls for assigned team on a daily basis and adhere to department standards for coverage.
  • Answer all voice mail at least every hour and respond to messages within 24 hours to ensure customer satisfaction is maintained.
  • Alert Nurse Reviewer of expedited requests.
  • Provide notifications to providers and members within 24-72 hours or by regulatory requirements.
  • Assist providers, patients, and internal and external customers regarding issues related to referrals.
  • Perform any additional duties that may not be inclusive in job description as requested by Management team that is within the scope of knowledge or ability of the Referral Coordinator.

Requirements

  • Minimum of two (2) years of experience with Referral Healthplan, IPA, or Medical Provider office with referral management and/or call center knowledge.
  • High School Diploma required.
  • Certified Medical Assistant preferred.