Referral Coordinator

Referral Coordinator

Salary Range $24.90 - $32.37/hr Position Type Full Time

Department/Care Stream: Patient Services

LIA Reporting Structure

Timecard Approver: Patient Services Manager

Primary: Patient Services Manager

Secondary: VP of Patient Pathways

Status: Full-Time

FLSA: Non-Exempt

Location: Admin Center

Organization Information

WellSpace's mission is "achieving regional health through high quality comprehensive care." We believe that everyone deserves to be seen, no matter who you are, where you come from, where you work or what place you call home. At WellSpace, we see you!

We are driven to serve the whole person through comprehensive, integrated care, spanning medical, dental, behavioral health, and supportive services across the region. We do this by building a team of exceptional colleagues who are dedicated to our mission and becoming part of the communities we serve.

As the region's largest Community Health System, WellSpace utilizes a Confluence Model to integrate an internal network of healthcare modalities, including Federally Qualified Health Centers (FQHC), Certified Community Behavioral Health Center (CCBHC), Drug Medi-Cal and Specialty Mental Health programs, California's second largest 988 Suicide and Crisis Lifeline Center, an independent Risk Bearing Organization (WellSpace Nexus), and more into a seamless confluence of care.

To ensure the highest quality of care, WellSpace is accredited by the Joint Commission for Ambulatory Care, Behavioral Health and as a CCBHC. Further, it is certified by the Joint Commission as a Primary Care Medical Home and a Behavioral Health Home. WellSpace's crisis programs are accredited by the American Association of Suicidology and the International Council for Helplines.

Position Summary

The Referral Coordinator must collect a variety of information in an extremely accurate manner in a fast paced environment, while maintaining patient confidentiality. Must be able to use various complex tools to register and schedule patients. Must be highly skilled in verbal and written communication.

Required Qualifications

• High School Diploma or equivalent.
• Medical Assistant training/certification preferred.
• Two plus years related experience preferred OR an equivalent combination of education and experience sufficient to successfully perform the essential duties of the job.
• Communicate clearly and concisely, both verbally and in writing and demonstrate a high level of listening skills.
• Fluency in additional languages preferred.
• Excellent interpersonal skills.
• Exceptional customer service experience including active listening, problem solving, and the ability to remain calm in emotional or stressful situations.
• Strong administrative skills with attention to detail.
• Commitment to HIPAA and ability to abide by standards of professional ethics and maintain confidentiality.
• Computer (PC) literate in Microsoft Word, Excel, Powerpoint, Outlook email and database software.
• Database software and Electronic Health Records Systems experience, NextGen preferred.
• Requires understanding of health insurance concepts and requirements, including HMO, PPO, Medicare, Medi-Cal, and other federal and state agency programs.
• Requires knowledge of medical and billing terminology (ICD-9/10 and CPT codes).
• Work flexible schedule when needed.
• Able to take and follow through with delegated tasks and accountability.
• Demonstrated commitment to the provision of services for the underserved and sensitivity working with a variety of people from low-income populations, with diverse educational, lifestyle, ethnic, and cultural origins; disabled, homeless, substance users, HIV (AIDS) infected, and/or physiologically impaired.

Essential Responsibilities

• Receives referrals, verifies for completeness and appropriateness, and communicates with referral sources to obtain additional information as needed.
• Processes and tracks referrals and diagnostic orders.
• Keeps accurate patient records and verifies insurance requirements.
• Obtains and completes all necessary insurance authorization as appropriate in a timely and thorough manner to maximize quality of patient care, with knowledge of insurance benefits, in/out of network requirements, pre-determination services, and medical necessity.
• Maintains ongoing tracking and appropriate documentation on referrals keeping status and outcome of requests to promote and warrant patient care.
• Ensures complete and accurate registration, including patient demographic and current insurance information.
• Assembles information concerning patient's clinical background and referral needs.
• Per referral guidelines, provides appropriate clinical information to specialist.
• Contacts organizations and insurance companies to ensure prior approval requirements are met.
• Presents necessary medical information such as history, diagnosis and prognosis.
• Reviews details and expectations about the referral with patients.
• Assists patients in problem solving potential issues related to the Health Care System, financial or social barriers.
• Be the system navigator and point of contact for patients and families, having direct access for asking questions and concerns. May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
• Identifies and utilizes cultural and community resources.
• Generates and electronically transmits the summary of care document to the specialist prior to patient appointment for all care transitions.
• Establishes and maintains relationships with identified service providers.
• Communicates with community organizations, health plans, outside facilities, and specialists to ensure that referrals are addressed in a timely manner.
• Coordinates specialty and diagnostic appointments with patients and specialists/facilities.
• Schedules patients for initial specialty referral appointments.
• Follows protocols and WellSpace Health Guidelines provided for handling referrals and directing effectively using the procedures given.
• Communicates with team mates and management if there is a lack of understanding on procedures.
• Participates in meetings as required.
• Performs other tasks as assigned.

Benefits

Successful candidate will receive regionally competitive salary, above average health benefits at reduced costs, company paid life insurance & long-term disability insurance, additional voluntary retirement plan with company match and no vesting schedule requirement.

• Paid bereavement and jury duty leave
• 11 paid holidays per year
• Paid time off
• Paid sick leave
• Flexible Spending Program
• Company paid malpractice insurance for all providers
• Professional development hours offered annually

Physical Demands and Work Environment

The work environment is characteristic of a medical clinic environment. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is frequently required to sit; use hands and arms to reach. The employee is also required to stand; walk; and reach with hands and arms. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, and the ability to adjust focus. The employee must also possess hearing and speech to communicate in person and over the phone. The noise level in the work environment is usually quiet.

The employee may be in contact with individuals and families in crisis who may be ill, using substances and/or not attentive to personal health and safety for themselves or their homes. The employee may experience a number of unpleasant sensory demands associated with the client's use of alcohol and drugs, and the lack of personal care. The employee may also be exposed to bodily fluids (blood, urine) and hazardous chemicals.

WellSpace Health is committed to the principals of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. It is the intent of WellSpace Health to maintain a work environment free of harassment, discrimination, or retaliation because of age, race, religious creed, color, national origin, ancestry, physical disability, medical condition, genetic information, marital status, sex (including pregnancy, childbirth, breastfeeding and/or related medical conditions), gender, gender identity, gender expression, sexual orientation, military or veteran status, or any other status protected by federal, state or local laws. WellSpace Health is dedicated to the fulfillment of this policy in regard to all aspects of employment, including but not limited to recruiting, hiring, placement transfer, training, promotion, rates of pay