Referral Coordinator Spanish Speaking -Needed Asap!

The Care Coordinator is a highly visible customer service and patient-focused role that works directly with our patient population and their families, insurance representatives and outside vendors, physicians, clinicians and other medical personnel in a dynamic and professional environment to provide the highest level of quality healthcare to our members.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Coordinates and processes patient referrals to completion with precision, detail and accuracy.

Definition of completion:

• Prioritizes HPP patients in Primary Care Physicians panel, stats, expedites and orders over 5 days.
• Schedules patient (Preferred Providers List of Specialist) and notifies them of appointment information, including, date, time, location, etc.
• Uses Web IVR to generate authorizations (Availity, Careplus, Healthhelp NIA and any other approved web IVR for authorization processing).
• Completes orders with proper documentation on where patient is scheduled and how patient was notified.
• Referrals have been sent to specialist office & confirmed receipt.
• Prepares and actively participates during physician/clinician daily huddles utilizing RITS Huddle Portal and huddle guide. Effectively communicates the physicians/clinicians needs or outstanding items regarding to patients.
• Enters all Inpatient and Outpatient elective procedures in HITS tool.
• Ensures patient's external missed appointment are rescheduled and communicated to the physician/clinician.
• Participates in Super Huddle and provides updates on high priority patients referrals.
• Addresses referral based phone calls for Primary Care Physicians panel.
• Completes and addresses phone messages within 24 hours of call.
• Checks out patients based on their assigned physician/clinician. (Note: If assigned Care Coordinator is unavailable at the time of check out, a colleague shall assist patient. This process does not apply to Care Specialist)
• Retrieves consultation notes from the consult tracking tool.
• Follows up on all Home Health and DME orders to ensure patient receives services ordered.

EDUCATION AND EXPERIENCE CRITERIA:

• High School diploma or equivalent required
• A minimum of 1 year of relevant work experience in customer service, patient referrals, and/or insurance verification required
• Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred
• Healthcare experience in a clinical setting, preferably within the Medicare HMO population is a plus
• Medical Assistant certification preferred
• CPR for Healthcare Providers is preferred

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Vision insurance
• Wellness program

Weekly day range:

• Monday to Friday
• No weekends

Experience:

• Insurance verification: 1 year (Required)
• Web IVRs: 1 year (Required)
• Obtaining referrals/authorizations: 1 year (Required)
• ICD coding: 1 year (Preferred)

Language:

• Spanish (Required)

License/Certification:

• CPR Certification (Required)

Work Location: In person