Referral Coordinator

CenterPlace Health believes that each employee makes a significant contribution to our success. That contribution should not be limited by the assigned responsibilities. Therefore, this position description is designed to highlight the primary duties, qualifications, and scope of the position, but not limit the incumbent nor the Company to only the work identified. It is our expectation that each employee will offer his/her full capabilities wherever and whenever necessary to ensure the success of our endeavors.

JOB DESCRIPTION
Summary:
The Referral Coordinator is responsible for coordinating specialty care or outside scans, and x-rays for patients in need of external consultation as requested by the primary care physician. The Referral Coordinator researches referral requests in a timely manner and ensures it meets medical necessity with thorough documentation to obtain prior authorization. The referral Coordinator also prioritizes all urgent referrals and makes sure the loop is closed in a timely manner.
Essential Functions:

Referral Coordinator Duties:

• Duties of this position include but are not limited to
• Review referrals completed by providers within the EHR, Open referral and verify procedure for accuracy, contact provider for additional information, if needed,
• Contact the insurance company & verify patient insurance coverage
• Send/fax patient notes to the insurance company, Obtain procedure authorization from the insurance company
• Coordinate peer to peer review with provider and insurance medical representative for cases where there is a procedure disagreement,
• Note procedure authorization number on medical record
• Communicate with the facility to schedule procedure date/time

Provide patients with directions to location when needed * Updating provider on any STAT referral issues

• Discussing with provider if any issues come up on a referral. For example, patient has no insurance and can’t get to referral appointment due to ride issues. Or the specific appointment is scheduled out a long time. This is not a complete list of things that may happen. Communication and documentation are keyElectronic Health Record (EHR):

• Accurately and efficiently enters documentation into the EHR.
• Ensures necessary patient referral information is available in the EHR prior to visit.
• Demonstrates basic understanding of the EHR

Cover PSR Clerical Duties as needed:

• Performs clerical duties as directed by office manager.
• Schedule’s appointments.
• Takes phone messages.
• Scan’s information into the Electronic Health Record.
• Performs patient registration functions.
• Workflow dashboard (working in referral Bucket)
• Order entry and workflow

Manage work queues:

• Performs other duties as assigned
• Completes all required trainings and attends meetings as assigned.
• Protects/observes patient confidentiality per policies and procedures.
• Assures translation, as needed, for non-English speaking patients.
• Recognizes and responds appropriately to violent/abusive situations, bomb threats, fire, and emergency situations.

Minimum Qualifications: (Experience/Skills/Abilities/Education/Certifications):

• High School diploma or GED equivalent.
• Some knowledge on how to use third party vendors to complete referral/authorizations (Availity, Medicare, Medicaid websites, etc.)
• Demonstrates good oral and written communication skills.
• Ability to effectively interact with physicians, patients, and other staff members
• Effective use of the Electronic Health Record
• Possesses basic Typing Skills
• Demonstrates knowledge of proper, safe, efficient usage of current office equipment/software.
• Demonstrates knowledge and ability to use Office 365 programs including Outlook, Word, and Excel.

Preferred Qualifications: (Experience/Skills/Abilities/Education/Certifications):

• Preferred 1 year working in a medical office
• Bilingual preferred

Physical Demands:
While performing the duties of this job, the employee is regularly required to stand; walk, often for prolonged periods; use hands to finger, handle, or feel; reach with hands and arms; stoop, kneel, crouch, or crawl; and see, speak, and hear. The employee must regularly lift and/or move up to 10 pounds and frequently lift and/or move up to 25 pounds.

Work Environment:
General office work

Supervisory Responsibilities:
None

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Education:

• High school or equivalent (Preferred)

Experience:

• Referrals: 1 year (Preferred)
• Insurance verification: 1 year (Preferred)

Work Location: One location