Referral Coordinator

Job Title: Referral Coordinator

FLSA Status: Non-exempt

Bilingual (English & Spanish) Required

Grade: N/A

Department: Operations

Title of Supervisor: Manager, Referrals

Date: June 2023

Position Summary

The Referrals Coordinator is responsible for working within the Epic system and insurance portals to process all ACCESS referrals that are generated by the clinical providers, to ensure that the patient is being referred to the appropriate in-network provider, and that the services are approved as stipulated by the patient's current benefit plan requirements.

Core Job Responsibilities

Work with Payors/Plans to process referrals/authorizations to completion according to policy and procedure.

Assist Access Clinic providers/staff in identifying appropriate in-network providers for referred services.

Assist patients with questions regarding referrals.

Coordinate with other departments and facilities to ensure appointments are scheduled and patients have received the necessary information for their appointment(s).

Work/address the referrals that remain open to determine if patient received the referred services. Contact Referred to provider to obtain consultation notes. Contact patients per established policy and procedure to ensure they receive referred services. Close referrals per established policy and procedure.

Build and maintain relationships with Payor/Plan representatives and ACCESS clinic providers and staff; acts as a resource to answer questions and solve problems

Maintain accurate information regarding what services require prior authorization for each Payor/Plan.

Maintain accurate information regarding which external providers are contracted with each Payor/Plan.

Monitor for delays in the prior authorization process and works with the Prior Authorization Department to ensure timely scheduling.

Monitor referral phases to maintain compliance

Monitor referral dashboards and work queues daily

Perform other duties as assigned.

Requirements/Preferences

High school diploma or GED required

Minimum 1-year experience in a clinical office or health care environment in patient registration, referrals, medical assisting or customer service required.

1-year EHR Systems experience, preferred, EPIC a plus

Bilingual/Spanish preferred

Beginning proficiency Microsoft Office Suite (Word, Excel, Outlook)

Competencies/Behaviors

Strong customer service orientation

Communication - strong written, oral, and presentation skills; share information that aligns with audience needs (especially via phone)

Organization - organize and prioritize duties and responsibilities; effective multi-tasking, detail oriented, accurate

Interpersonal skills -interact with patients and staff in a friendly and respectful manner; approachable

Problem Solving - identify/define problems; gather data, establish facts, and draw valid conclusions escalate issue to manager when appropriate

Collaborative; work within a team

Flexibility/adaptability - flexibility on the job, readily respond to changing circumstances, expectations and changing work demands

Emotional Intelligence - exhibits confidence, empathy and respect when communicating with customers (patients), leadership and staff

Cultural competency - experience and ability to work in a multi-cultural environment; shows respect and openness towards individuals whose social and cultural background is different from one's own.

Working Conditions/Equipment

Health Center environment

Remote working options; must have a suitable and secure remote working environment

Ability to sit for up to 4 hours at a time

Computer/laptop

Phone/Fax/Copier/Scanner

EMPLOYEE EXPECTATIONS

Following are guidelines of expectations for all employees of this organization. These guidelines are incorporated as part of your job description.

Maintain current knowledge in your area of skill and expertise and strive to improve your own work.

As an employee you are expected to do the following:

Report to work on time as scheduled. You should be at your work assignment ready to begin work at scheduled starting times. Observe break times appropriately.

Be courteous, friendly, helpful, and supportive. Use a person's name and use such phrases as "please," "thank you," and "may I help you?" whenever appropriate.

Make efficient use of your time at work. Establish priorities with your supervisor and use your time wisely.

Promote team spirit. Work together and cooperate in an effort to promote quality client services and enhance staff relationships. Help fellow staff members perform their work. Share responsibilities. Recognize others' achievements

Communicate effectively. Be open, honest, and truthful with yourself and others. Talk to your supervisor. Ask questions. Give your supervisor pertinent information, stating the facts without concealing or exaggerating.

Anticipate and meet client needs. Be observant of and react to individual client needs. Client dignity is of primary importance.

Maintain an appropriate appearance. Make sure clothing is clean and you are neatly groomed. It is important to portray a positive image.

Participate in making quality of work better. Suggest improvements to your supervisor. Help others learn correct procedures. Be open to new ideas and methods.

Know the structure, philosophy, and purpose of the organization. Know how you fit into the structure and purpose of the organization. Maintain and promote the philosophy of the organization.