Referral Coordinator

Referral Coordinator

The Patient Care Referral Coordinator (PCRC) works in partnership with the Clinical Services care teams to coordinate continuity of care between providers and community specialists to process and track routine and urgent referrals, specialty consults, diagnostic imaging, follow-up care, and prior authorizations.

Required Education and Experience:

• High School diploma, G.E.D. or equivalent.
• Two years' experience in a healthcare setting.
• Minimum of two years in insurance verification and benefits eligibility with understanding of various health insurance plans, and billing terminology (ICD-10 and CPT codes).
• Exceptional internal/external customer service, in a manner that is culturally sensitive and bridges linguistic and cultural differences.

Preferred Education and Experience:

• Experience with Electronic Medical Records Systems, eClinicalWorks preferred.
• Must have excellent time management skills, organized, and self-motivated.
• Maintain high productivity and work well in a team environment.
• Proficient in Microsoft Office programs, including Word, Excel, PowerPoint and Outlook and eClinicalWorks electronic health record system (EHR).

Required Skills/Abilities/Certifications/Licenses:

• Bilingual English and Spanish with effective verbal and written communication skills
• Analytical and critical thinking skills to resolve conflicts and problem solving to meet the patient's needs.
• Ability to plan, prioritize, and organize work and adapt to possible changes to plan as necessary.
• Ability to maintain patient confidentiality and adhere to HIPAA regulations and PHI.
• Ability to function in high-volume, multiple-task environments in a closely shared workspace.
• Ability to adhere to La Clinica's Code of Ethical Standards.
• Quality/Compliance: Achieving a standard of excellence with our work processes and outcomes.
• Patient Focused: Striving for high patient satisfaction, going out of our way to be helpful and pleasant, and making it as easy as possible for the patient.
• Communication: Balancing listening and talking, speaking, and writing clearly and accurately, keeping others informed. Being helpful, respectful, approachable, and team-oriented, building strong working relationships and a positive work environment
• Initiative: Taking ownership of the work, doing what is needed without being asked, and following through.
• Efficiency: Planning, managing time well, being on time, being cost conscious, thinking of better ways to do things.
• Coachable: Being receptive to feedback, willing to learn, embracing continuous improvement.

Duties and Responsibilities:

• Point of contact for patients and specialists regarding any questions or raising concerns. Assist in problem-solving potential issues related to their referral due to language or social barriers, and transportation assistance. If unable to help, assist in finding the right point of contact to help further.
• Receive and document requests from the Medical and Mental Health providers prioritize referrals and prior authorizations by urgency and promptly address them while adhering to our Standard Operating Procedures (SOP).
• Maintain accurate tracking and appropriate documentation. Identify procedures, visits that require prior authorizations, request authorization, and submit supporting documents to insurance.
• Completes urgent referrals within 24 hours as requested and non-urgent referrals within 5 business days.
• Assists and schedules referral appointments directly on behalf of the patient. Remind patients of their approved specialty appointments via mail or phone. Reviews details and expectations about the referral with patient and is point of contact for patients on referral submission progress and updates.
• Follow-up on pending referrals to include sending certified letters to non-adherent patients.
• Closing referrals; ensure that referrals have consultation notes and a report documented within one month of the visit. Contact the responsible party if a consultation note/report is missing within one month of the visit (Pre-visit Planning).
• Meets key performance indicators by maintaining ongoing tracking and documentation for referrals and diagnostic imaging.
• Submit the service request to the appropriate organization and track the monthly volume of outgoing referrals per provider.
• Sort, scan and attach documents to the orders in eClinicalWorks and assign documents appropriately for review.
• Keeps the referral list of providers and facilities up to date in eClinicalWorks.
• Participates in quality and process improvement initiatives to provide excellent quality of care to patients and efficient operations.
• Enforce LCDP's policies and procedures to patients as needed; seeks management support as required.
• Completes assigned tasks and responsibilities within established guidelines and scope of practice.
• Attends monthly team, all-staff meetings and LCDP's activities.
• Complies and stays current with all mandatory training.
• Complies with federal and local patient privacy laws.
• Performs other tasks as needed under the direction of the Health Center Manager or designated staff.

Physical Requirements:

• Prolonged periods of sitting and working at a computer.
• Must be able to lift and/or move up to 15 pounds at times

Equal Opportunity Employer. We affirm all identities at La Clnica and expect all employees to welcome and work with colleagues and clients, regardless of sexual orientation, gender identity, race/ ethnicity, country of origin, language, other ability, age, religion, or other identity.