Referral Coordinator

Job Description

Job Description

INTRODUCTION:

Central Neighborhood Health Foundation is a Federally Qualified Healthcare Center (FQHC) committed to the Triple Aim as described by the Institute for Healthcare Improvement. Improving the US health care system requires simultaneous pursuit of three aims: 1) improving the experience of care, 2) improving the health of populations, and 3) reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population.

SUMMARY:

Upholds and supports the philosophy, objectives, and policies of the office under the direction of the office manager and physician(s).

ESSENTIAL DUTIES AND RESPONSIBILITIES include but are not limited to the following functions:

• Responsible for the accurate completion and processing of referral requests from CNHF PCPs as well as from other PCPs to other providers, e.g., specialists, DME, diagnostic testing, etc. Also responsible for the processing of follow-up referral requests from specialists, following the timeliness guidelines in the Policy and Procedure Manual.

• Ensure that phone calls are answered promptly and courteously, and that the correct information is relayed to the caller as appropriate.

• Responsible for the upkeep of the current Provider Directory to ensure that the correct contracted providers are being referred to.

• Maintenance of referral logs.

• Responsible for maintaining DHS and NCQA standards and requirements.

• Responsible for notifying patients of the status of their referral in a timely manner; Stat referrals in 2 hours. Urgent in 24 hours, regular in 3-4 days, mammography results in office within 7 days, and Specialist consultation reports within 30 days. To include phone call, mail, or fax as is necessary and/or appropriate.

• Responsible for accurate filing of referrals in patients' charts with all needed documentation.

• Act as a patient liaison between the UM/QM Departments and the Health Plans to help the patient access care more readily.

• File all necessary information in the patient’s charts, e.g., copies of insurance cards, X-Ray reports, lab reports, hospital notes, referrals, consult notes, etc.

• Assist the physician with other duties as requested.

• Display a friendly, professional attitude with patients, other staff, and the Physicians.

• Keep patient records confidential.

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE:

• High School Diploma

• Bilingual English and Spanish preferred.

• CPR Certification preferred

SKILLS AND SPECIFICATIONS:

• Ability to handle confidential and sensitive information.

• Ability to communicate effectively on the telephone.

• Ability to relate to persons with diverse educational, socioeconomic, and ethnic backgrounds.

• Ability to handle a “call center” environment; work quickly and multitask.

• Ability to exercise good judgment to handle calls appropriately.

• Ability to demonstrate good customer service.

WORK ENVIRONMENT

Described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Variations in conditions may occur under certain circumstances.

CONFIDENTIALITY

Maintains patient, employee, and Foundation confidentiality at all times, discussing patient or employee business only with appropriate parties who have a bona fide need to know; and communicating only the minimum amount of information necessary with respect to protected health information (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

1. AGREEMENT AND ACCEPTANCE

2. I HAVE READ THE ABOVE JOB DESCRIPTION AND FULLY UNDERSTAND THE REQUIREMENTS SET FORTH AND WILL PERFORM ALL DUTIES AND RESPONSIBILITIES TO THE BEST OF MY ABILITY.