REFERRAL COORDINATOR

Description IMMEDIATE SUPERVISOR: Site Director (Brighton) SUPERVISORY RESPONSIBILITIES: None WORK LOCATION: Onsite PAY RANGE: Band 2 ($20.00/hour - $26.00/hour) WHO YOU ARE YOUR ROLE & IMPACT The mission of Charles River Community Health (CRCH) is to partner with individuals and families so they can thrive and lead healthier lives by delivering the comprehensive, integrated, and equitable primary healthcare that matters most to them. The Referral Coordinator will work collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers, patients, and other parties to ensure that required referral management referrals and prior authorizations for specified specialty visits and other services are obtained and appropriately recorded in the relevant practice management systems for patient appointments. They will utilize available reports to follow up on unresolved issues and denied claims. They will also manage logistics, including appointment arrangements, transportation, and translation services and will support the Lead Referral Coordinator in managing the electronic referral system. Location: 495 Western Ave., Brighton, MA with regular travel to our Waltham location at 43 Foundry Ave . This role is primarily onsite as it requires a strong in-person presence. After 90 days there is potential for one remote day per week. Remote work depends on many factors and is not guaranteed. YOUR RESPONSIBILITIES Coordinate all outgoing/incoming referrals and prior authorizations. Schedule all referral appointments, including urgent requests, radiology exams, procedures and consultations. Verify insurance eligibility and submit insurance referrals and prior authorizations to ensure services are covered. Document appointment information on EHR, notify provider and patient with details, and mail out appointment letter. Prepare documentation, including office notes and labs, to fax to specialist office for upcoming appointment. Collaborate with the primary care provider to resolve issues related to specialist availability and patient needs. Process insurance referrals and prior authorizations received by fax and phone line from patients and hospitals. Scan and drop file insurance referrals in patient’s chart for easy access to authorization numbers, number of visits, and utilization. Maintain up-to-date knowledge of insurance company requirements and where patient’s insurance is accepted. Function as a resource for information and problem solving for patients, primary care providers, referral management program staff, specialists, and Health Center staff. Maintain and follow through closing the loop on all tracked referrals. Maintain HIPAA at all times. Understand the mission of the Health Center and strive to work collaboratively with Health Center staff to carry out this mission. Attend appropriate meetings to maintain up to date knowledge of Health Center activities and, if unable to attend meetings, follow up with supervisor for information. Attend appropriate various external organizational meetings with insurance companies and hospitals to remain up to date on any changes. Maintain documentation to meet audit requirements and participates in audit activities as requested. Perform other duties as assigned by Site Director or designee. YOUR QUALIFICATIONS, COMPETENCIES, TRAITS High school diploma or GED required. Must have previous experience in a health care setting. Detail-oriented with strong communication and organizational skills. Familiarity with referral management plans and computer skills highly preferred. Team-oriented, with a strong commitment to helping others. Bilingual in Spanish preferred. Ability to complete 50-60 referrals per week depending of complexity. Ability to answer high call volumes with attention to detail. Must have a willingness to work flexible hours to meet the organization's needs/demands. Must be able to travel to either Charles River Community Health site (Brighton and Waltham) as needed. Must have excellent communication skills, particularly with people from diverse cultures, with the ability to understand the community, population, and patients we serve. Must believe in the work we do at CRCH, with a strong passion to serve underserved populations in diverse settings. OUR BENEFITS & PERKS Medical & Dental Insurance Short & Long-term Disability Insurance Generous Paid Time Off Flexible Spending Account Employee Assistance Program Tickets at Work Health Reimbursement Arrangement Travel Reimbursement Professional Development Opportunities Solid track record of developing and promoting employees internally! Charles River Community Health is strongly committed to diversity and a workplace environment that respects, appreciates and values employee differences and similarities. By providing and supporting a work culture that fosters and builds upon diversity and its strengths, CRCH will better serve our local communities and continue to provide quality patient care and services. CRCH is an employment at-will organization and an equal opportunity employer committed to maintaining a work and learning environment free from discrimination on the basis of sex, race, color, religion, national origin, pregnancy, gender identity, sexual orientation, marital/civil union status, ancestry, place of birth, age, citizenship status, veteran status, political affiliation, genetic information or disability, as defined and required by state and federal laws. Additionally, CRCH prohibits retaliation against an applicant or employee because he or she has engaged in protected activity under the statutes prohibiting discrimination in the workplace. #J-18808-Ljbffr