Referral Coordinator

Job Title

In collaboration with patients, families (as defined by the patient) and staff across all disciplines and departments is responsible for coordinating all aspects of the patient referral process in a community healthcare center setting and for adhering to established timelines and departmental procedures.

Duties And Responsibilities

Monitors templates for appointment availability
Assists in the expansion of the referral department through the orientation and training of new team members under the direction of the Triage and Referral Nurse Manager
Schedules appointments per clinic guidelines as appropriate
Conducts auditing of records for the referral team as needed
Gathers pertinent information from insurance carriers, financial counselors, or other staff regarding appointments to determine financial responsibility
Obtains referral authorization from insurance carriers for specialty services and relay such authorizations (or denials) to the patient and provider
Resolves pre-authorization, registration, or other referral related issues prior to a patient's appointment
Contacts patients verbally or in writing per current protocol
Maintains updated referral resources
Upholds and completes referrals ensuring that the entire referral process is complete
Ensures referral Standard Operating Procedures are followed for all referrals
Ensures referral requests received from the PCP are addressed in a timely fashion
Ensures that all documentation is completed in EPIC
Ensures referrals are completed in an appropriate timeframe to meet patient needs for access to services
Completes all direct and indirect care documentation in timely manner and ensure patient records are current and complete
Attends team huddles and scheduled meetings
Attends seminars and maintain all licensure and/or certification requirements for continuing education and best practices
Participates in quality strategies to evaluate compliance with evidence-based guidelines/standards and to identify opportunities to improve patient outcomes
Ensures all tasks provided and associated with patient care, patient administrative processes, and related duties comply with all regulatory and accreditation standards including The Joint Commission and CommUnityCare Standard Operating Procedures and CommUnityCare Policies and Procedures
Develops and maintain favorable internal relationships, partnerships with co-workers, including clinical managers, clinical support staff, providers, and business office staff
Interacts respectfully and collaboratively with patients and their families, striving to develop favorable relationships with families
Collaborates with all members of the care team in providing patient-centered care
Meet defined productivity standards
Performs other duties as assigned

Knowledge/Skills/Abilities

Demonstrates a high level of skill at building relationships and providing excellent customer service
Inhibits a strong attention to detail and accuracy
Has the ability to utilize computers for data entry and information retrieval
Shows excellent verbal and written communication skills
Demonstrates knowledge of federal, state, and local insurance regulations
Demonstrates knowledge of the referral process for a variety of insurance plans
Demonstrates success in researching and resolving complex issues
Demonstrates familiarity and proper care of electronic devices common GUIs found within most health care environments (for example, personal computer skills, spreadsheets, word processing, patient record systems, EHR systems, etc)

Qualifications

Minimum Education: High School Diploma or equivalent
Minimum Experience: Three years' experience in the healthcare field including one year experience as a Medical Assistant, Medical Administrative Clerk, Patient Services Representative, or Dental Assistant