Referral Coordinator

POSITION SUMMARY:

Under the direct supervision of the Clinic Director II, the Referral Coordinator is responsible for managing all patient referrals to specialists, diagnostic testing, and outside healthcare providers. This role ensures timely and accurate coordination of referrals, prior authorizations, and follow-up, while maintaining excellent communication with patients, providers, and insurance companies. The Referral Coordinator plays a key role in supporting continuity of care and enhancing the patient experience.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Work as part of the team of Referral Coordinators to ensure receipt, review and processing of all provider referral requests.
• Verify patient insurance eligibility and benefits related to referrals and authorizations.
• Obtain prior authorizations from insurance companies as required.
• May schedule referral appointments directly on behalf of patient, as needed.
• Track and follow up on referrals to confirm appointment completion and ensure receipt of consult/specialty notes in a timely manner.
• Ensure referrals are addressed and closed in a timely manner, as determined in relevant policies and procedures.
• Ensure that patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.
• Coordinates with clinical team on patient inquiries regarding referral.
• Maintain accurate and up-to-date referral logs and documentation in the electronic health record (EHR).
• Responsible for auditing information entered in EHR to ensure compliance with capturing necessary data as required by reporting agencies.
• Communicate with providers regarding referral status, barriers, or delays.
• Communicate with Supervisor when unable to process all referrals or follow-ups to avoid delays.
• Serve as a patient advocate by providing education and guidance regarding referral processes and answer patient questions and address concerns.
• Ensure compliance with requirements of HIPAA, OSHA, other application regulations and all agency/clinic policies and protocols.
• Complete and comply with all mandatory trainings
• Participate in staff meetings, agency meetings, planning meetings, and other meetings as needed.
• Prepare and submit monthly reports of activities as requested.
• Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.
• Participate in quality improvement initiatives related to referral management, providing feedback and suggestions to streamline processes and enhance patient care.
• Effectively communicate with clients/patients in English and Spanish as required per aforementioned job duties.

OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.

REQUIREMENTS:

Training and Experience:

• High school diploma or equivalent; and at least one year of experience in a healthcare/clinical setting, preferably in referrals, scheduling, or medical office administration. Bilingual required – English/Spanish.

Knowledge of:

• Basic medical terminology, insurance processes, managed care and IPA’s and referral/prior authorization requirements.
• Safety policies and safe practices applicable to the work.
• Proficiency in electronic health record (EHR) systems, eCW preferred, and Microsoft Office Suite.
• Knowledgeable about CPT and ICD-10 codes.

Ability to:

• Provide patient-centered, trauma-informed and empathetic communication with medically-underserved individuals.
• Problem-solve and navigate insurance/authorization complexities.
• Time management and ability to prioritize multiple tasks.
• Attention to detail and accuracy.
• Embrace continuous improvement.
• Ability to work with diverse populations; exercise tact, objectivity, sensitivity, sound judgement and decision making in dealing with a variety of people in a variety of sensitive situations.
• Must exhibit cooperativeness, punctuality, dependability and be receptive to new ideas.
• Demonstrated flexibility and the ability to function in a fast-paced, dynamic clinical environment.
• Understand and follow written and oral instructions from physicians, mid-level providers and nurses and apply departmental policies, guidelines and protocols applicable to APLA Health.
• Communicate effectively, both orally and in writing, with people of various educational, socio-economic and cultural backgrounds.
• Work as part of a dynamic team.

WORK ENVIRONMENT:

• Clinic-based, with direct interaction with patients, providers, and external offices.
• May require occasional extended hours depending on referral volume.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper.

COVID-19 and Booster or Medical/ Religious Exemption required.

APLA Health is an Equal Opportunity Employer

Salary : $26 - $29