Referral Coordinator - Full-Time

Description

Under the general direction of the Practice Manager and the Chief Operations Officer, the Referral Coordinator will ensure referral and transition coordination activities; and effectively coordinate customer service requirements with on-site clinical personnel, in accordance with TJC, federal, state, and local guidelines, organizational and departmental policies and procedures. Communicates with medical staff, other departments, and outside agencies while maintaining confidentiality. Position requires self-motivation, creativity, and capabilities to function in a semi-autonomous role within a fast pace and dynamic environment. 

STANDARDS OF PERFORMANCE

Responsible for coordinating all outside referrals, appointments, and authorizations for outside diagnostic testing and other services. You will also be responsible for scheduling, tracking, and communication with patients to ensure completion of all physician referrals.

2. Accurately enter notes into EMR regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications. These documents should also be scanned into the appropriate patient's chart in the EMR.

3. Maintain on-going tracking and appropriate documentation on referrals.

4. Document all interactions on an account.

5. Assemble information concerning patient's clinical background and referral needs. Provide appropriate clinical information to specialist.

6. Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis and prognosis.

7. Assist patients in problem solving potential issues related to the health care system, financial or social barriers.

8. Ensure that referrals are addressed in a timely manner.

9. Remind patients of schedule appointments via mail or phone.

10. May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.

11. Will also be required to work as needed in the clinical environment (depending on clinical certification and licensure – see applicable job description) in times of heavy patient flow or need.

12. Will participate in continuing education, both clinical and non-clinical.

13. Ensures adherence to proper infection control, OSHA, and safety standards.

14. Performs other duties as assigned or required.

Requirements

Minimum Level of Education: Education level equivalent to completion of high school, and a completion of a course of study resulting in a Medical Assistant or Licensed Practical Nurse degree.

Formal Training: Skill and experience in planning, organizing, implementing, facilitating, verbal and written communications. Must possess basic typing skills; have the ability to manage cash and give change; and use proper telephone etiquette.

Licensure, Certification, Registration: Must have and maintain an unencumbered certification or licensure as Medical Assistant or Licensed Practical Nurse.

Work Experience: Two to three years medical office experience and experience with medical referrals. Must have a working knowledge of MS Excel and MS Word ICD-9 or higher and CPT coding, general knowledge of insurance plans and billing. 

Tools and Equipment Used:

Calculator, personal computer, telephone, facsimile machine, paper shredder, copier, printer, standard nursing/physician office equipment.