Referral Coordinator

Job Summary

The Referral Coordinator works with the care team to process and track routine and urgent referrals to facilitate the process for specialty consults, follow-up care, and prior authorization when necessary. Make appropriate referrals to/for other services and resources available (e.g., medical, dental, etc.).

About the Role

• Verifies insurance prior to completing referrals
• Completes urgent referrals within 24 hours as requested
• Affixes non-urgent referrals within 5 business days
• Ensures that referrals have a consult note/report documented within one month of the visit and contacts responsible party if a consult note/report is missing within one month of the visit
• Obtains prior authorization when required by insurance carrier
• Participates with in-services audits as instructed by supervisor
• Responsible for referral tracking and documenting what steps are outstanding in the process before the order can be marked complete in the EMR
• Ensure transition of care is completed for providers
• Carry out various quality assurance activities such as any client feedback regarding problems with access or quality of services and communicating findings to relevant entity

Major Duties And Responsibilities

• Checking, Examining, and Recording
• Verifies insurance prior to completing referrals
• Completes urgent referrals within 24 hours as requested
• Affixes non-urgent referrals within 5 business days
• Ensures that referrals have a consult note/report documented within one month of the visit and contacts responsible party if a consult note/report is missing within one month of the visit
• Analytical and Critical Thinking
• Obtains prior authorization when required by insurance carrier
• Participates with in-services audits as instructed by supervisor
• Responsible for referral tracking and documenting what steps are outstanding in the process before the order can be marked complete in the EMR
• Ensure transition of care is completed for providers
• Carry out various quality assurance activities such as any client feedback regarding problems with access or quality of services and communicating findings to relevant entity
• Communication
• Clearly and effectively interacts with members of the care team to communicate information
• Reads/responds to voicemail, EPR, and e-mail several times daily
• Assures timely follow up and communication
• Document in EMR steps taken to complete the referrals and prior authorizations have been completed timely and thoroughly
• Notifies patient of referral details
• Patient Focus
• Identifies patient needs and issues and works to resolve the problems while advocating for the patient
• Demonstrates a desire to understand patient’s needs and how the organization can meet those needs
• Workplace Computers and Equipment
• Handle telephone and written inquiries
• Enter information into Patient Management System and EMR
• Detects and corrects errors, completes forms, obtains needed information and maintains logs and files
• Enters referral information into EMR utilizing appropriate insurance panel
• Faxes referral and supporting documentation to specialist office in advance of the scheduled appointment
• Responsible for marking referrals complete in the EMR after the required outside medical documentation is received

Compliance, Policy, and Procedure

• Maintains patient confidentiality
• Complies with federal and local patient privacy laws
• Verifies patient and/or guardian identification
• Document services by initiating appropriate forms, entering client data into the EMR and ensuring all documentation is appropriately signed and dated
• Present ideas and suggestions when opportunities for improvement present of existing services based on interactions

Teamwork

• Maintains open relationships and lines of communication with co-workers
• Work with a multidisciplinary team to establish rapport and improve patient outcomes

Skills And Abilities

• Some medical terminology
• Basic understanding of HIPAA and PHI
• Basic navigational knowledge of electronic medical record applications such as CPS12
• Must have excellent time management skills, be organized, self-motivated
• Possess excellent written, verbal, and interpersonal communication skills
• Maintain a high level of productivity and confidentiality
• Work well in a team environment
• Can enter data with ability to check accuracy of detail work such as correct spelling of names, numbers, dates and times
• Ability to handle multiple tasks at once without mistakes or diminution of professional demeanor and customer service
• Effectively able to prioritize and maintain workflow
• Ability to function in a high volume, multiple task environments, possibly in a closely shared workspace
• Demonstrate self motivation and the ability to work with a high degree of independence
• Ability to effectively and efficiently solve problems as presented in real time
• Strong organizational and task prioritization skills

Education And/Or Experience Required

• High school, G.E.D. or equivalent
• One year of customer service experience