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Referral Coordinator

2 months ago

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Job Description

The Referral Coordinator plays a crucial role in the healthcare industry, responsible for preparing referrals and addressing stat line requests. This position requires strong organizational skills, attention to detail, and effective communication with various stakeholders.

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, and document pertinent information in IDX to include medical notes, benefit information, and contracted vs non-contracted provider.
  • 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.
Qualifications:
  • 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.