Referral Coordinator

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.

Benefits:

• Free Medical, Dental & Vision
• 13 Paid Holidays + PTO
• 403 (B) retirement match
• Life Insurance, EAP
• Tuition Reimbursement
• SEIU Union (if applicable)
• Flexible Spending Account
• Continued workforce development & training
• Succession plans & growth within

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education & Experience

• Associates Degree or equivalent to 5+ years in the healthcare setting
• Bi-lingual English/Spanish
• Proficient Microsoft office and Excel
• Medical Terminology
• EHR- Electronic Health Records
• Strong customer service focus
• Effective verbal and written communication skills
• Teamwork orientation
• Organize and able to manage competing priorities
• Good judgment
• Resourcefulness in problem solving

ESSENTIAL DUTIES AND RESPONSIBILITIES including but not limited to:

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