Referral Coordinator - Bilingual Spanish

Essential Functions

• Schedules, solves problems, communicates, and coordinates referral appointments with outside specialists upon receipt of the Referral Order from designated Claremedica Provider.
• Maintains 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.
• Perform miscellaneous administrative tasks as required by the Referral Management Supervisor.

Qualifications

• High school diploma, GED or equivalent experience required.
• Minimum of 1 year of experience processing referrals, as an MA or other clinical/front desk experience preferred.
• 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.
• 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.