Referral Coordinator

Patient Referral Coordinator

In collaboration with patients, families (as defined by the patient) and staff across all disciplines and departments is responsible for coordinating all aspects of the patient referral process in a community healthcare center setting and for adhering to established timelines and departmental procedures.

Duties And Responsibilities

Monitors templates for appointment availability

Assists in the expansion of the referral department through the orientation and training of new team members under the direction of the Triage and Referral Nurse Manager

Schedules appointments per clinic guidelines as appropriate

Conducts auditing of records for the referral team as needed

Gathers pertinent information from insurance carriers, financial counselors, or other staff regarding appointments to determine financial responsibility

Obtains referral authorization from insurance carriers for specialty services and relay such authorizations (or denials) to the patient and provider

Resolves pre-authorization, registration, or other referral related issues prior to a patient's appointment

Contacts patients verbally or in writing per current protocol

Maintains updated referral resources

Upholds and completes referrals ensuring that the entire referral process is complete

Ensures referral Standard Operating Procedures are followed for all referrals

Ensures referral requests received from the PCP are addressed in a timely fashion

Ensures that all documentation is completed in EPIC

Ensures referrals are completed in an appropriate timeframe to meet patient needs for access to services

Completes all direct and indirect care documentation in timely manner and ensure patient records are current and complete

Attends team huddles and scheduled meetings

Attends seminars and maintain all licensure and / or certification requirements for continuing education and best practices

Participates in quality strategies to evaluate compliance with evidence-based guidelines / standards and to identify opportunities to improve patient outcomes

Ensures all tasks provided and associated with patient care, patient administrative processes, and related duties comply with all regulatory and accreditation standards including The Joint Commission and CommUnityCare Standard Operating Procedures and CommUnityCare Policies and Procedures

Develops and maintain favorable internal relationships, partnerships with co-workers, including clinical managers, clinical support staff, providers, and business office staff

Interacts respectfully and collaboratively with patients and their families, striving to develop favorable relationships with families

Collaborates with all members of the care team in providing patient-centered care

Meet defined productivity standards

Performs other duties as assigned

Knowledge / Skills / Abilities

Demonstrates a high level of skill at building relationships and providing excellent customer service

Inhibits a strong attention to detail and accuracy

Has the ability to utilize computers for data entry and information retrieval

Shows excellent verbal and written communication skills

Demonstrates knowledge of federal, state, and local insurance regulations

Demonstrates knowledge of the referral process for a variety of insurance plans

Demonstrates success in researching and resolving complex issues

Demonstrates familiarity and proper care of electronic devices common GUIs found within most health care environments (for example, personal computer skills, spreadsheets, word processing, patient record systems, EHR systems, etc)

Qualifications

Minimum Education : High School Diploma or equivalent

Minimum Experience : Three years' experience in the healthcare field including one year experience as a Medical Assistant, Medical Administrative Clerk, Patient Services Representative, or Dental Assistant