What are the responsibilities and job description for the Referral Coordinator position at BAKERSFIELD FAMILY MEDICAL GROUP, INC.?
Under the direction of the Supervisor, this position is responsible to assist the nurse case management staff with preparing for upcoming patient appointments by retrieving medical records and providing those records to the nurse case manager timely. The Referral Coordinator will also assist with submitting referrals for patients when needed. The Referral Coordinator will interact with other departments, clinic personnel, and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.
1.1To be efficient in the use of UM prior authorization systems utilized.
1.2 Be a resource for providers and case management staff in regard to questions regarding network specialists.
1.3 Ability to prepare authorizations and refer to appropriate providers/facilities within 1 business day of receiving the request.
1.4 Guide and communicate with physician office, processing staff and other departments as needed to ensure collaboration and open discussion regarding all aspects of the referral process. Including responding to messages within next business day.
1.5 Review accuracy of pending referrals for ICD-10, CPT, HCPC code and provider selections.
1.6 Ensure referral data entry has been accurately inputted into UM systems based on the referral and clinical information submitted.
1.7 Have a complete understanding of established policy and procedure within Heritage Provider Network regarding the authorization processes.
1.8 Ensure that the approved authorization and supporting documentation is faxed to the approved provider office.
1.9 Document all efforts in the patient's chart in NextGen.
1.10 Review the Priority Care patient schedule 1 week in advance to confirm which patients will need medical records obtained.
1.11 Review the scheduled patients' brain sheet that the nurse case manager will update consistently to confirm the specific medical records needed.
1.12 Contact provider office to request visit notes be faxed over for upcoming appointment.
1.13 Retrieve available medical records from external online sites i.e., RadNet, LabCorp, DocStar.
1.14 Provide medical records to the nurse case manager prior to the patient's upcoming appointment.
1.15 Maintain assigned duties in an acceptable, organized manner.
1.16 Inform management on a daily basis when problems arise or when work falls behind.
1.17 Provide Referral Coordinator coverage as needed.
1.18 Adaptable to regulation and necessary departmental procedure changes that affect UM prior authorization processes.
1.19 Maintain patient confidentiality.
1.20 Cultural and Linguistics training required annually.
1.21 Other duties as assigned.
Requirements:
8.1 High School graduate or GED certification required.
8.2 One-year minimum experience working in a medical office environment (IPA or HMO preferred) with prior authorizations required.
8.3 Knowledge of medical terminology, required.
8.4 Knowledge of HCPC, CPT and ICD-10, required.
8.5 Proficient written and oral communication skills.
8.6 Demonstrate proficiency in computer systems utilized.
8.7 Ability to remain organized and able to manage competing priorities.
8.8 Demonstrate good judgement.
8.9 Demonstrate the ability to take and follow through with delegated tasks and accountability.
8.10 Demonstrate resourcefulness in problem-solving.
8.11 Ability to successfully multi-task.
The pay range for this position at commencement of employment is expected to be between $24.27 and $28.55 However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
Compensation: Between $24.27 and $28.55
1.1To be efficient in the use of UM prior authorization systems utilized.
1.2 Be a resource for providers and case management staff in regard to questions regarding network specialists.
1.3 Ability to prepare authorizations and refer to appropriate providers/facilities within 1 business day of receiving the request.
1.4 Guide and communicate with physician office, processing staff and other departments as needed to ensure collaboration and open discussion regarding all aspects of the referral process. Including responding to messages within next business day.
1.5 Review accuracy of pending referrals for ICD-10, CPT, HCPC code and provider selections.
1.6 Ensure referral data entry has been accurately inputted into UM systems based on the referral and clinical information submitted.
1.7 Have a complete understanding of established policy and procedure within Heritage Provider Network regarding the authorization processes.
1.8 Ensure that the approved authorization and supporting documentation is faxed to the approved provider office.
1.9 Document all efforts in the patient's chart in NextGen.
1.10 Review the Priority Care patient schedule 1 week in advance to confirm which patients will need medical records obtained.
1.11 Review the scheduled patients' brain sheet that the nurse case manager will update consistently to confirm the specific medical records needed.
1.12 Contact provider office to request visit notes be faxed over for upcoming appointment.
1.13 Retrieve available medical records from external online sites i.e., RadNet, LabCorp, DocStar.
1.14 Provide medical records to the nurse case manager prior to the patient's upcoming appointment.
1.15 Maintain assigned duties in an acceptable, organized manner.
1.16 Inform management on a daily basis when problems arise or when work falls behind.
1.17 Provide Referral Coordinator coverage as needed.
1.18 Adaptable to regulation and necessary departmental procedure changes that affect UM prior authorization processes.
1.19 Maintain patient confidentiality.
1.20 Cultural and Linguistics training required annually.
1.21 Other duties as assigned.
Requirements:
8.1 High School graduate or GED certification required.
8.2 One-year minimum experience working in a medical office environment (IPA or HMO preferred) with prior authorizations required.
8.3 Knowledge of medical terminology, required.
8.4 Knowledge of HCPC, CPT and ICD-10, required.
8.5 Proficient written and oral communication skills.
8.6 Demonstrate proficiency in computer systems utilized.
8.7 Ability to remain organized and able to manage competing priorities.
8.8 Demonstrate good judgement.
8.9 Demonstrate the ability to take and follow through with delegated tasks and accountability.
8.10 Demonstrate resourcefulness in problem-solving.
8.11 Ability to successfully multi-task.
The pay range for this position at commencement of employment is expected to be between $24.27 and $28.55 However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
Compensation: Between $24.27 and $28.55
Salary : $24 - $29
