Referral Coordinator

Essential Functions

The primary duty of a Referral Coordinator is working with patients to arrange and schedule referral appointments. Depending on the office, this can include providing patients with referrals to other care providers, managing incoming patient referrals, or both. Referral Coordinators set appointments, send reminders, and provide patients with information about referral appointments.

• Maintain a current working knowledge of all health plan carrier requirements for referral request authorizations and approval requirements.
• Provide excellent service and attention to customers when face-to-face or through phone conversations.
• Schedule initial and follow-up appointments for specialist and imaging facilities.
• Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.
• Assemble information concerning patient's clinical background and referral needs.
• Per referral guidelines, provide appropriate clinical information to specialists.
• Contact review organizations and insurance companies to ensure prior approval requirements are met.
• Present necessary medical information such as history, diagnosis, and prognosis.
• Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians, including requesting medical records as needed.
• Review details and expectations about the referral with patients.
• Aid patients in problem-solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
• Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns.
• 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.
• Identify and utilize cultural and community resources.
• Establish and maintain relationships with identified service providers.
• Ensure that referrals are addressed in a timely manner.
• Remind patients of scheduled appointments via mail or phone.
• Assist with miscellaneous administrative tasks as required by the Operations Lead.

Qualifications

• High school diploma, GED or equivalent experience required.
• Minimum 1 year experience processing referrals.
• Educated on and compliant with HIPAA regulations; maintains strict confidentiality of client information.
• Exceptional oral and written communication skills, time management skills and organizational skills.
• Ability to communicate with employees, patients and other individuals in a professional and courteous manner.
• Mindset focused on resolving problems for patients and achieving team goals.
• Knowledge of medical products, terminology, services, standards, policies and procedures.
• Ability to act calmly in busy or stressful situations.
• Demonstrated strong listening skills.
• Ability and willingness to travel locally and/or regionally up to 10% of the time to assist in covering other centers, as needed.
• Proficient skills in Microsoft Office Suite products including Word, PowerPoint, Outlook and Excel plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software.
• Must be able to type at least 40 WPM.
• Skilled in basic phone and computer operation.
• Ability to work effectively within role independently and with other team members.
• Ability to organize and complete work in a timely manner.
• Detail-oriented to ensure accuracy of reports and data.
• Profound ability to problem solve, multitask, and carry out instructions.
• Bilingual is a plus.
• HIPAA and AHCA experience preferred.
• Healthcare experience preferred.
• EMR system experience preferred.