Description

The Referral Coordinator prepares clinical data for physician/IPP/CBO approval and obtains authorizations; acts as liaison between patient, medical assistant, physician, IPP, CMS Department and Central Business Office.

• Call and/or utilize appropriate portal to obtain referral authorizations for Cal Optima, TAR, Medi-Cal or any appropriate supported program patient is participating in.
• Gather documentation that supports the medical necessity of the requested referral to authorized Specialist.
• Obtain referral authorization with pre-authorized specialist, notify patient and update patient ‘s chart. 
• Prepare patient records and send to Specialist’s office in readiness for the appointment. 
• Obtain progress notes and documentation from patient’s specialist visit and update patient’s file for Community Providers to follow-up.
• Send documentation for authorization to specialty departments such as Radiology, labs, etc. notify patient and update patient’s chart.
• Obtain specialty (ex. radiology or lab) results and process notes and update the patient’s chart for the Community Providers for review. 
• Maintain a Provider Referral Log. Ensure information regarding a referral is documented and entered timely into patient’s file. 
• Utilize excel template to track referral information. 
• Communicate with fellow Referral Coordinators any updates, changes or closures of patient cases. 
• Utilizes knowledge of alternative sources for specialty care.
• Support fellow caregivers by assisting in sharing knowledge or training. 
• Attends and participates in committee meetings as required.
• Front Support as needed.
• Creates and sustains respectful, inclusive positive working relationships. 
• Communicates to manager any challenges or questions regarding work responsibilities and assists in creating a solution. 
• Other duties as assigned. 

Requirements

Education:

• High School Diploma or equivalent

License/ Certifications:

• N/A

Experience:

• One year experience with medical terminology, coding and medical charting.

Knowledge/Skills/Abilities:

• Operates all general business equipment and assists office with all clerical needs.
• Knowledge of grammar, spelling, coding and medical terminology.
• Proper telephone etiquette.
• Ability to read, understands, and follow oral and written instruction.
• General knowledge of healthcare insurance benefit and terminology.
• Demonstrates the ability to read, write and speak English and Spanish without an interpreter.