Referral Coordinator Specialist

5 days ago

Orange, California, United States Prospect Medical Full time
Job Summary

We are seeking a highly organized and detail-oriented Referral Coordinator to join our team at Prospect Medical. The successful candidate will be responsible for preparing referrals, addressing stat line requests, and completing daily tasks and queues as assigned.

Key Responsibilities
  • Prepare referrals and address stat line requests in a timely and accurate manner.
  • Complete daily tasks and queues as assigned, ensuring compliance with regulatory requirements.
  • Assist the Referral Nurse and Medical Directors with additional information needed for completion.
  • Document pertinent information in Aerial Comments and IDX referral system.
  • 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, and document all pertinent information in IDX.
  • Maintain timeliness standards by regulatory requirement for each product line.
  • Maintain daily production standards 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.
  • School Diploma required.
  • Certified Medical Assistant preferred.

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