The Referral Coordinator is a highly visible customer service and patient-focused role. The Referral Coordinator will work directly with our patient population and their families, insurance representatives and outside vendors, physicians, clinicians and other medical personnel to ensure the referral process runs smoothly. A Referral Coordinator operates in a dynamic and professional environment ensuring that the highest level of quality healthcare is delivered to our members.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Coordinates and processes patient referrals to completion with precision, detail and accuracy.

Definition of completion:

• Prioritizes HPP patients in Primary Care Physicians panel, stats, expedites and orders over 5 days.
• Schedules patient (Preferred Providers List of Specialist) and notifies them of appointment information, including, date, time, location, etc.
• Uses Web IVR to generate authorizations (Availity, Careplus, Healthhelp NIA and any other approved web IVR for authorization processing).
• Completes orders with proper documentation on where patient is scheduled and how patient was notified.
• Referrals have been sent to specialist office & confirmed receipt.
• Prepares and actively participates during physician/clinician daily huddles utilizing RITS Huddle Portal and huddle guide. Effectively communicates the physicians/clinicians needs or outstanding items regarding to patients.
• Enters all Inpatient and Outpatient elective procedures in HITS tool.
• Ensures patient's external missed appointment are rescheduled and communicated to the physician/clinician.
• Participates in Super Huddle and provides updates on high priority patients referrals.
• Addresses referral based phone calls for Primary Care Physicians panel.
• Completes and addresses phone messages within 24 hours of call.
• Checks out patients based on their assigned physician/clinician. (Note: If assigned Care Coordinator is unavailable at the time of check out, a colleague shall assist patient. This process does not apply to Care Specialist)
• Retrieves consultation notes from the consult tracking tool.
• Follows up on all Home Health and DME orders to ensure patient receives services ordered.

EDUCATION AND EXPERIENCE CRITERIA:

• High School diploma or equivalent required
• A minimum of 1 year of relevant work experience in customer service, patient referrals, and/or insurance verification required
• Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred
• Healthcare experience in a clinical setting, preferably within the Medicare HMO population is a plus
• Medical Assistant certification preferred
• CPR for Healthcare Providers is preferred

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Vision insurance
• Wellness program

Weekly day range:

• Monday to Friday
• No weekends

Application Question(s):

• Do you have knowledge of medical terminology, CPT, HCPCS and ICD coding?

Experience:

• Insurance verification: 1 year (Required)
• Patient Referral: 1 year (Required)
• Web IVR: 1 year (Required)

Language:

• Spanish (Required)

Work Location: In person