Referral Coordinator

Referral Coordinator

The Referral Coordinator works with the care team to process and track routine and urgent referrals to facilitate the process for specialty consults, follow up care and prior authorization when necessary. Make appropriate referrals to/for other services and resources available (e.g., medical, dental, etc.).

Major duties and responsibilities include checking, examining, and recording referrals, obtaining prior authorization when required by insurance carrier, participating in in-services audits as instructed by supervisor, ensuring transition of care is completed for providers, carrying out various quality assurance activities, clearly and effectively interacting with members of the care team to communicate information, reading/responding to voicemail, EPR, and e-mail several times daily, assuring timely follow up and communication, documenting in EMR steps taken to complete the referrals and prior authorizations have been completed timely and thoroughly, notifying patient of referral details, identifying patient needs and issues and working to resolve the problems while advocating for the patient, demonstrating a desire to understand patient's needs and how the organization can meet those needs, handling telephone and written inquiries, entering information into Patient Management System and EMR, detecting and correcting errors, completing forms, obtaining needed information and maintaining logs and files, entering referral information into EMR utilizing appropriate insurance panel, faxing referral and supporting documentation to specialist office in advance of the scheduled appointment, responsible for marking referrals complete in the EMR after the required outside medical documentation is received, maintaining patient confidentiality, complying with federal and local patient privacy laws, verifying patient and/or guardian identification, documenting services by initiating appropriate forms, entering client data into the EMR and ensuring all documentation is appropriately signed and dated, presenting ideas and suggestions when opportunities for improvement present of existing services based on interactions, maintaining open relationships and lines of communication with co-workers, working with a multidisciplinary team to establish rapport and improve patient outcomes.

Skills and abilities include some medical terminology, basic understanding of HIPAA and PHI, basic navigational knowledge of electronic medical record applications such as CPS12, excellent time management skills, be organized, self-motivated, excellent written, verbal, and interpersonal communication skills, maintaining a high level of productivity and confidentiality, work well in a team environment, enter data with ability to check accuracy of detail work such as correct spelling of names, numbers, dates and times, ability to handle multiple tasks at once without mistakes or diminution of professional demeanor and customer service, effectively able to prioritize and maintain workflow, ability to function in a high volume, multiple task environments, possibly in a closely shared workspace, demonstrate self motivation and the ability to work with a high degree of independence, ability to effectively and efficiently solve problems as presented in real time, strong organizational and task prioritization skills.

Education and/or experience: Required: High school, G.E.D. or equivalent. Required: One year of customer service experience. Desired: One (1) year experience in medical office environment; Experience with Electronic Medical Records Systems.