Referral Coordinator

3 weeks ago


Orange, California, United States Prospect Medical Full time

As a Referral Coordinator at Prospect Medical, you will play a vital role in preparing referrals and addressing stat line requests. Your daily tasks will include completing assigned queues, assisting the Referral Nurse and Medical Directors with additional information, and documenting 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.
  • Document all 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.
  • Special projects as assigned which may include CCS, OIG, Unused/Expired, Fax Failure, IHA, NOMNC etc.
  • 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:

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

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