Referral/Prior Authorization 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.

High School diploma, G.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.

Experience with Electronic Medical Records Systems, eClinicalWorks preferred.

Proficient in Microsoft Office programs, including Word, Excel, PowerPoint and Outlook and eClinicalWorks electronic health record system (EHR).

Bilingual – English and Spanish with effective verbal and written communication skills

Quality/Compliance: 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

Efficiency: Planning, managing time well, being on time, being cost conscious, thinking of better ways to do things.

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).

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.

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.

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; Complies and stays current with all mandatory training.

Complies with federal and local patient privacy laws.

Prolonged periods of sitting and working at a computer.

We affirm all identities at La Clínica 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.