Referrals Coordinator

Referrals Coordinator

Under the direct supervision of the Director of Managed Care Services, the Referrals Coordinator is responsible for assuring all assigned specialty and ancillary referral orders are completed and processed accurately and in a timely manner as per agency's Utilization Management Policy 107; Specialty Care Referrals.

Duties:

• Responsible for providing care coordination and patient access to specialty care in accordance with Arroyo Vista UM Policy 107, the Joint Commission's Patient-Centered Medical Home (PCMH) standards and contracted managed care agencies guidelines.
• Responsible for communicating with patient and/or caregiver, the referring provider and specialty offices, as necessary and in compliance with agency care coordination policy standards. Including but not limited to providing support with appointment scheduling, rescheduling, contact with offices, authorizations and modifications, redirection of services, retrieval of specialist progress notes, etc.
• Responsible for using standards of documentation and maintaining confidentiality as per Agency policy and procedures. Including documentation of care coordination efforts and case progress in the EHR and Population Management system.
• Responsible to verify patient eligibility when processing a new case and periodically to ensure appropriate workflow is followed and contracted specialist network is used.
• Responsible for closing the referral loop on a timely manner per PCMH, managed care and agency timeline policy. Assures all urgent referrals are processed within 48 hours and that referral orders are closed when a specialist report is received or if authorization is denied, or if patient refuses services or is non-compliant after multiple attempts with the objective of facilitating continuity of quality care and minimizing risk exposure.
• Responsible for preparing, assisting, and/or submitting monthly progress reports as assigned to the immediate supervisor.
• Responsible for active participation in the Quality Management Program, Safety Program, Emergency Preparedness and Infection Control Programs, and is responsible for Joint Commission and IPA/HMO Standard Compliance of Patient Referral Utilization Review Services.
• Responsible to attend assigned in-services and educational sessions to maintain current knowledge for effective practice.
• Responsible to serve as back-up to other members of the Referral Team.
• Responsible to perform other duties as assigned by the supervisor.

Requirements:

• Certificate from an approved and accredited Medical Assistant Program. Familiar with medical terminology, including CPT and Diagnosis coding.
• Minimum one (1) year clinical experience in an ambulatory care facility. Referrals experience preferred.
• Attention to detail, with excellent follow-through skills.
• Excellent communication skills.
• Ability to work well with others in a professional manner in a team oriented environment.
• Bilingual (English/Spanish). Familiarity with Hispanic culture preferred.
• Computer literacy in health information systems. Proficient in Microsoft.
• The employee is familiar and knowledgeable with the use of a type of health information technology system. The employee will assure to take such steps necessary to allow Arroyo Vista to realize the benefits of the Electronic Health Records system including the adoption, implementation, upgrading and meaningful use of such technology as requested or required by Arroyo Vista or other federal or state authority.