Care Coordinator-Referrals

Description

Reports To: Care Coordination Manager

Employee Status: Non-Exempt (Regarding Overtime)

Position Summary: The Care Coordinator works in collaboration with Primary Care & Hope Clinic Medical and Behavioral providers and outside providers to assist patients and their families with the coordination of their healthcare.

Essential Functions:

Care Coordination:

• Represent PC&HC to patients/visitors in a caring, courteous, and professional manner. Provide prompt, efficient, and accurate patient service.
• Perform health insurance enrollment-related duties, including responding to requests for information; generating interest in enrollment through outreach, application assistance, and follow-up; documentation of activities; access, utilization, and retention duties; and related tasks.
• Assess the physical, functional, social, psychological, environmental, and financial needs of clients/patients; identify a cost-effective comprehensive plan to meet the families’ health care needs and implement the plan.
• Assess the client’s formal and informal support systems. 
• Promote timely access to appropriate care
• Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals

Referral Program:

•  Make appropriate and timely referrals to specialist, DME or home health agency per request of provider.
• Contact the insurance carriers and initiate the referral process.
• Remain current on insurance pre-authorization requests.
• Respond promptly to calls from patients regarding the referral process.
• Compile all pertinent medical data and supporting documentation and fax or mail to appropriate specialist.
• Act as liaison between practice, patients, and referral sources complaints and problems.
• Plan and organize workload to maintain efficient patient operations in the health center.
• Prioritize patient referrals when needed. 
• Locate and verify the participating specialist or specialty services always keeping the list current.
• Obtain pre-authorization from insurance carriers or other third-party payer or services to be rendered to patients at other locations. 

Marginal Functions

• Improve the patient experience and health care processes and help assure the provision of high quality health care, as well as an ongoing process of performance improvement.
• Completes all required paperwork
• Perform all other duties as required or assigned.

Requirements

Requirements

· Must have a high school diploma or equivalent

· Education or experience in healthcare healthcare-related field preferred

· Must be willing to become a Certified Application Counselor for health insurance enrollment purposes.

· Must communicate with patients in a friendly, positive manner.

· Must be able to operate office-related equipment.

· Must follow HIPAA and OSHA requirements.

· Must be supportive of our mission to provide healthcare to the underinsured and uninsured.