POSITION SUMMARY:  The Referral Coordinator is responsible for follow-up and closing out external referrals, once initiated by a provider.  Follows protocols for proper authorization and processing of all referrals.  Communicates with the patient on a timely basis for all scheduling requirements. Completes all administrative functions associated with referral activities in a timely manner. Enters all referral, hospital, outpatient, and other patient health service authorizations into the computer system according to agency policy and procedure.  Responsible for creating and monitoring referral reports. Communicates with care teams to coordinate appointments daily. The individual displays responsible behaviors, communicates effectively to others and functions as a member of the healthcare team.

AGENCY PERFORMANCE STANDARDS

  • Maintain high level of professionalism and ensure confidentiality.
  • Treat clients, staff, volunteers, board members, etc., with dignity and respect.
  • Offer assistance to co-workers as needed.
  • Demonstrate initiative by actively participating in the resolution of problems.
  • Ask for assistance when learning new information or job duties.
  • Take all necessary measures to properly use and maintain supplies and equipment.
  • Respect the rights of co-workers to a productive workplace.

COMPLIANCE & QUALITY ASSURANCE STANDARDS

  • Requires cooperation with the Agency’s Quality Assurance and Improvement Program. Includes actively participating in all required trainings, and in creating a culture of quality improvement. Cooperation with the quality program will be considered for performance reviews. 
  • Requires cooperation with the Agency’s Compliance Practices. Includes immediately reporting issues, actively participating in required trainings, following HIPAA regulations, and assisting in creating a culture of compliance. Also includes compliance with written standards and all applicable federal and state laws. Cooperation with compliance will be considered for performance evaluations. 
  • Not currently listed as excluded or sanctioned by the Department of Health and Human Services, Office of Inspector General (OIG), the General Services Administration (GSA), or excluded from participation in any federal program.  Agrees to promptly notify supervisor in the event of any such debarment, exclusion, conviction, threat or indictment occurring during the term of employment. 
  • Failure to comply with the Agency’s Compliance Practices, which include failure to report conduct or events that potentially violates any laws or the Agency’s written compliance standards will be met by disciplinary action, up to and including possible termination. 
  • Must adhere to all practices specified in the Employee Handbook and Agency Operating Procedures

ESSENTIAL PERFORMANCE STANDARDS

  • Facilitates submission of referral information to specialty providers as ordered by the provider.
  • Maintains ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. This tracking may use an IT database, and EHR.
  • Schedule, facilitate, communicate, and coordinate referral appointments with outside medical providers.
  • Assists with obtaining – demographic, financial and clinical and other pertinent data – needed to document the need for the referral and provide data to secure prior authorizations when required.
  • Contact referral organizations and insurance companies to ensure prior approval. requirements are met. 
  • Secure necessary medical information such as history, diagnosis and prognosis.
  • Assist case managers and/or providers to coordinate additional community resource referrals as determined by the client’s case manager or PMC.
  • Interfaces daily with all clinic providers and care teams to coordinate/facilitate completion of referrals to external specialists.
  • Serves as the primary contact for the coordination of patient referral calls and communications to external entities
  • Review details and expectations about the referral with patients, communicates any pertinent information and instructions.
  • Ensures referral outcome information is received and filed appropriately  
  • Maintain accurate records of external referral patient’s appointments completed or not complete and post updates in the Electronic Health Record (EHR).  Outstanding provider reports that are 30 days or more old will be reported to the provider and outreach to the specialist will be performed. 
  • The position will interface with patients/clients to assist as needed with case coordination and completion of the referral visit.
  • Verify insurance information for referral purposes and process insurance information for referral patients.
  • Ensure that all referral data is updated in the client/patient file in the appropriate sections of the EHR.
  • Ability to communicate effectively with patients and all levels of personnel in a professional, courteous and effective manner using excellent customer service skills
  • Possess excellent communication and organizational skills with the ability to multi task, set priorities, and meet deadlines
  • Perform follow-up calls to clients and referral offices to confirm completion of appointments as needed.

POSITION REQUIREMENTS

  • Bachelor’s Degree with experience in a medical setting, LPN or Medical Assistant (MA) preferred.
  • Necessary technical skills to use Agency’s electronic health record, incident reporting system, email, and other information systems.
  • Experience in medical office and familiarity of medical terminology preferred but not required.
  • Spanish language ability desired, not required.
  • Strong customer service focus
  • Effective verbal and written communication skills