Referral Coordinator - Middle, Tn

About rural healthcare group (“RHG”)

Rural Healthcare Group is a leading provider organization on a mission to improve the lives of people living in underserved communities through high-quality primary care. By creating a positive and motivating environment for our clinic-teams, we can improve the way we show up for our patients, and ultimately improve their experience and health outcomes. When our clinics thrive, so do our patients and communities.

Job Overview: Referral Coordinator

The Referral Coordinator must have an active LPN license and is responsible for referral operations at assigned clinics, establishing and standardizing systems and procedures for the distribution and use of health information throughout the organization. The Referral Coordinator has many responsibilities, such as organizing patient information, ensuring complete and accurate registration, and providing appropriate clinical data to specialists and other healthcare facilities. A good Referral Coordinator must have excellent attention to detail since they will be responsible for the organization and accuracy of several patient files at the same time.

The Referral Coordinator performs a wide range of administrative duties to include referral processing, verification of benefits, insurance authorizations, patient appointment scheduling, communication to patients regarding referrals, communication with referral sources and other tasks assigned.

Essential Job Functions, Duties, and Responsibilities:

The following list of duties is not intended to be restrictive or all inclusive. The fact that certain duties may not be listed does not limit the assignment of additional and/or other duties.

• Responsible for the tracking, coordination, and communication of patient referrals
• Ensures complete and accurate patient registration, including demographics and current insurance information
• Serves as point person for multidisciplinary evaluation process to include patient scheduling, third party communications, and internal communications
• Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist and/or healthcare facility
• Contact review organizations and insurance companies to ensure prior approval requirements are met and present necessary medical information such as history, diagnosis, and prognosis.
• Reviews details and expectation of referral with the potential patient
• Ensures that referrals are addressed in a timely manner
• Remind patients of scheduled appointments via portal, email, mail, or phone
• Communicates patient updates between clinic staff, providers, and referral sources to ensure patient information is complete
• Ensure that patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health
• Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety
• Understands and utilizes appropriate service networks for referrals based upon insurance plans and benefits coverage
• Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians
• Assist 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)
• Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers

Minimum Qualifications:

• Licensed Practical Nurse (LPN) – active, current and unrestricted license
• 2 years of experience in either referral coordination or utilization management
• 5 years of experience in healthcare

Must have:

• Knowledge of pertinent Federal, State, and local laws, codes, and regulations
• Exhibit a comprehensive understanding of healthcare regulatory and compliance (e.g., HIPAA) information
• Skilled in the application of policies and procedures
• Knowledge of business office standards and recommended practices
• Ability to collaborate with and educate providers regarding referral and prior authorization requirements
• Effective oral and written communication skills
• Be organized; able to set priorities and meet deadlines
• Proficient computer skills in eCW, Word, and Excel
• Must be able to work in a team environment and exhibit flexibility and enthusiasm in learning new information and developing new skills quickly
• Ability to work independently with minimal supervision after training
• Positive attitude and team player
• Ability to navigate in various electronic health records.
• Strong customer service focus
• Teamwork orientation
• Organized and able to manage competing priorities
• Good judgment
• Resourcefulness in problem solving
• Able to take and follow through with delegated tasks and accountability