Referral Coordinator - Sycuan Health Center

Job Purpose:

The Referral Coordinator is responsible for managing and coordinating all aspects of patient referrals to specialty providers, diagnostic services, and outside healthcare facilities. This role ensures timely and accurate processing of referrals, maintains strong communication with patients, providers, and insurance companies, and supports the care team in delivering seamless patient care.

Job Duties and Responsibilities:

(Note: Duties and responsibilities may be added, deleted, or changed at the sole discretion of Sycuan Management at any time)

Clerical and Administrative Support

• Answer multi-line phones, manage voicemails, emails, and faxes, and respond promptly.
• Perform scanning, data entry, document organization, and general office support.
• Schedule and confirm patient appointments.

Patient Interaction & Customer Service

• Collect demographic information and insurance details.
• Ensure all required forms are completed for new or returning patients.
• Provide excellent customer service by addressing patient questions and concerns professionally.
• Offer basic health education, including health promotion and disease prevention.

Referral Management

• Manage and process urgent and routine patient referrals daily.
• Prioritize referrals by urgency and track them through completion.
• Communicate with referring providers, specialty clinics, and insurance companies to coordinate care.
• Redirect or escalate referrals as necessary based on provider availability or care requirements.
• Maintain standardized referral workflows across departments (Family Practice, Women’s Health, Pediatrics).
• Document referral actions and communications in the referral tracking system and EHR.
• Participate in the selection, orientation, and training of referral personnel.
• Identify patients who may benefit from specific programs and collaborate with clinical staff.

Medical Records Administration

• Manage, prepare, and retrieve patient charts and records to support billing and clinical care.
• Organize and maintain health information in both paper and electronic systems.
• Process incoming and outgoing requests for medical records, ensuring appropriate authorization.
• Maintain HIPAA compliance in managing physical and electronic records.
• Update and ensure accuracy of patients’ Electronic Health Records (EHR).

Insurance & Authorization Coordination

• Assign codes for insurance reimbursement and verify patient insurance eligibility.
• Obtain and submit prior authorizations for appointments, tests, procedures, and referrals.
• Track authorization statuses and follow up to ensure timely processing.
• Collaborate with providers to reprocess denied authorizations when necessary.
• Communicate with insurance companies, providers, and Workers’ Compensation carriers to exchange essential information.
• Work with Workers’ Compensation carriers, including Tribal First, to coordinate patient care and documentation.

Specialized Workers’ Compensation Responsibilities

• Coordinate care with Tribal First and Human Resources for Workers’ Compensation patients.
• Communicate with Tribal First to ensure required information is submitted promptly.
• Accurately enter and update referral and authorization data in tracking systems and reporting modules (e.g., i2i).
• Submit required documentation and maintain compliance with regulatory timelines.
• Follow up with external providers to obtain consultation notes.
• Process outgoing medical record requests to SMDC patients and external parties (attorneys, insurance companies, government agencies).

Job Specifications:

Education and Experience:

Essential:

• High School Diploma or GED
• Current CPR Certification
• CA Driver’s License in good standing
• 2 years of experience in referrals and medical records
• 2 years of experience in a clinical setting

Desirable:

• Experience working in a Tribal clinical setting

Skills and Knowledge:

Essential:

• Ability to manage patient care workflows and protect sensitive health information HIPAA compliance and confidentiality
• Electronic Health Records (EHR), preferably NextGen
• ICD-10 coding knowledge
• Medical terminology proficiency
• Strong data entry and document scanning accuracy
• Appointment scheduling and coordination
• Medical records management
• Microsoft Office Suite (Outlook, Word, Excel)

Supervisory/Managerial Accountability:

Direct: None

Indirect: None