JOB SUMMARY:
The Referral Coordinator works with the care team to process and track routine and urgent referrals to facilitate the process for specialty consults, follow up care and prior authorization when necessary. Make appropriate referrals to/for other services and resources available (e.g., medical, dental, etc.).
MAJOR DUTIES AND RESPONSIBILITIES:
Checking, Examining, and Recording
* Verifies insurance prior to completing referrals.
* Completes urgent referrals within 24 hours as requested.
* Assist with scheduling urgent referral appointments with the referred specialist.
* Completes non-urgent referrals within 5 business days
* Ensures that referrals have a consult note/report documented within one month of the visit and contacts responsible party if a consult note/report is missing within one month of the visit.
Analytical and Critical Thinking
* Obtains prior authorization when required by insurance carrier.
* Participates with in-services audits as instructed by supervisor.
* Responsible for referral tracking and documenting what steps are outstanding in the process before the order can be marked complete in the EMR.
* Ensure transition of care is completed for providers.
* Carry out various quality assurance activities such as any client feedback regarding problems with access or quality of services and communicating findings to relevant entity.
Communication
* Clearly and effectively interacts with members of the care team to communicate information.
* Reads/responds to voicemail, EPR, and e-mail several times daily.
* Assures timely follow up and communication.
* Document in EMR steps taken to complete the referrals and prior authorizations have been completed timely and thoroughly.
* Notifies patient of referral details.
Patient Focus
* Identifies patient needs and issues and works to resolve the problems while advocating for the patient.
* Demonstrates a desire to understand patient's needs and how the organization can meet those needs.
Workplace Computers and Equipment
* Handle telephone and written inquiries.
* Enter information into Patient Management System and EMR.
* Detects and corrects errors, completes forms, obtains needed information and maintains logs and files.
* Enters referral information into EMR utilizing appropriate insurance panel.
* Faxes referral and supporting documentation to specialist office in advance of the scheduled appointment.
* Responsible for marking referrals complete in the EMR after the required outside medical documentation is received.
Compliance, Policy, and Procedure
* Maintains patient confidentiality
* Complies with federal and local patient privacy laws.
* Verifies patient and or/guardian identification.
* Document services by initiating appropriate forms, entering client data into the EMR and ensuring all documentation is appropriately signed and dated.
* Present ideas and suggestions when opportunities for improvement present of existing services based on interactions.
Teamwork
* Maintains open relationships and lines of communication with co-workers
* Work with a multidisciplinary team to establish rapport and improve patient outcomes.
SKILLS AND ABILITIES
* Some medical terminology
* Basic understanding of HIPAA and PHI
* Basic navigational knowledge of electronic medical record applications such as CPS12
* Must have excellent time management skills, be organized, self-motivated
* Possess excellent written, verbal, and interpersonal communication skills
* Maintain a high level of productivity and confidentiality
* Work well in a team environment.
* Can enter data with ability to check accuracy of detail work such as correct spelling of names, numbers, dates and times.
* Ability to handle multiple tasks at once without mistakes or diminution of professional demeanor and customer service.
* Effectively able to prioritize and maintain workflow.
* Ability to function in a high volume, multiple task environments, possibly in a closely shared workspace.
* Demonstrate self motivation and the ability to work with a high degree of independence.
* Ability to effectively and efficiently solve problems as presented in real time.
* Strong organizational and task prioritization skills.
EDUCATION AND/OR EXPERIENCE:
* Required: High school, G.E.D. or equivalent.
* Required: One year of customer service experience.
* Desired: One (1) year experience in medical office environment;
* Experience with Electronic Medical Records Systems