Referral Coordinator Jobs

JOB SUMMARY

Referral Coordinator plays a key role as part of the clinician team. The RC is responsible for assuring continuity of care for those patients with a referral order, by coordinating timely specialty referral process. The referral process is a multistep process, and the Referral Coordinator will work as a liaison between the PCP, Insurance carriers, specialty providers, and patient(s). The RC is responsible for data entry of referral information and documentation of all referral interventions.

Education & Experience

• Associates Degree or equivalent to 3+ years in the healthcare setting

• Bi-lingual English/Spanish

• Proficient Microsoft office and Excel

• Medical Terminology

• EHR- Electronic Health Records

• Excellent and Strong customer service focus

• Effective verbal and written communication skills

• Teamwork orientation

• Organized and able to manage competing priorities

• Good judgment

• Resourcefulness in problem solving

ESSENTIAL DUTIES AND RESPONSIBILITIES including but not limited to:

• Checks Referral Helpline telephone encounters and emails daily
• Assist with patient complaints
• Will attend meetings and training at collaborative and partnership events as in person as needed
• Manage and assign unassigned referrals to the appropriate Referral Coordinators and evaluate the effectiveness of RCs workload to ensure referrals are processed timely.
• Responsibilities are subject to change at Manager’s discretion
• Ensures compliance with regulatory requirements and application of clinical decision support criteria for care management activities deemed by Federal, State and other regulatory and accreditation agencies.
• Interacts with entities (IPA, Health Plans etc.) Medical Management staff including Medical Directors and St John’s Heath services Network, Clinic Manager and other staff.
• Records- requests an average of 95 specialty reports daily
• Uses medical terminology on regular basis for doctors and vendors.
• Seeks assistance of Supervisor when unable to process all referrals or follow-up’s to avoid backlog and the clinical consequences of delays
• Modifies CPT/ICD-10 Codes and extends authorizations as needed
• Acts as a Provider educator to assure that the Provider is aware of referral timeframes and communicates referral information to patient regarding his/her condition and patient is educated.
• Reassign eConsults to appropriate providers
• Authorization-meets productivity referrals processing of an average of 50+ referrals daily including a minimum of 50+ follow up actions
• Required to work one Saturday per month or as needed
• Assist the Referral Call Center as needed
• Access patient medical records and verifies eligibility via Medi-cal/Medicare, Health Plans web portals
• Handle high volume of incoming /outgoing calls and provides excellent customer service
• Train new staff and providers as needed
• Performs all other related duties assigned.
• Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.
• Uses Med Point, OPTUM, eConsult and LANES web portals for submitting authorizations
• Process routine referrals within 24-72 hours from date ordered
• Ensure PCP timely receives the specialty report and is scanned in the patient’s medical records.
• Review details and expectations about the referral with patients.
• Provides oversight of all referral/authorization, of case management and outpatient clinical care coordination functions.
• Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
• Upload specialist report in EMR within 24 hours from date received
• Process Urgent referrals within 24 hours of date ordered
• Assemble information concerning patient’s clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
• Notifies Supervisor when tasks are completed before end of business day to assist other team members if help is needed
• Serve as clinic liaison to outside agencies and partners.
• Able to cope in a “fast pace” work setting