Positions Available in : DTLA, Lynwood, Sherman Oaks, Van Nuys, & Panorama City.
Position Summary :
The role of a referral coordinator is to provide coordinated care to support families and assist with the utilization of benefits. The referral coordinator will collaborate with providers, PA, County, Medpoint Managemen,t etc... in order to provide coordinated quality care.
Duties :
1. Specialty Referral :
- Processes patient referrals accurately and in a timely manner.
- Reviews request for authorization for completeness and sends to IPA or County (RPS) in a timely manner.
- Follows-up on status of request for authorization and obtains approval in a timely manner. Works with referring provider to resolve denials or questions regarding referrals.
- Contacts specialty clinic to assist patients in getting timely appointments for the visit.
- Informs referring provider and obtains order for additional test(s) requested by the specialist. Obtains authorization for additional test(s) if needed.
- Provides patients with accurate information regarding referral including name of specialty provider, address and directions, date and time of the appointment and telephone number and a copy of referral form, if appropriate.
- Data entry of all referrals are to be tracked in our PMS or i2i system, including notes.
- Evaluates referral request for eligibility, benefit determination, preferred provider networks.
- Appropriate documentation according to internal policies and procedures.
- Works aggressively with physicians and physician office staff to obtain necessary medical information related to the referral request.
- Meets or exceeds Referral Department productivity targets on a weekly basis.
- Maintains files and records of referral activity.
- Assists with cross coverage with in the referral management team as assigned.
- Ensures integration of Referral Management activities with other areas of compliance, case management, and Quality Measures.
- Assist with the training of new personnel.
- Participate in the joint and coordinated actions of the referral coordination team.
- Demonstrates initiative, motivation and resourcefulness in day to day operations.
- Attend meetings as requested by supervisor.
- Performs other duties as assigned by supervisor.
2. i2i Referrals :
Process patient referrals accurately and in a timely manner.Reviews request for authorization for completeness and sends to IPA or County (RPS), if appropriate, in a timely manner.Assist patient (without insurance) enroll in programs that can cover services ex. Mammogram or pap.Follows up on status of request for authorization and obtain approval in a timely manner. Works with referring provider to resolve denials ro questions regarding referrals.Ensures that progress notes are continuously updated for provider review.Ensure that on a provider can close any case related to the care of a patient.Contacts Specialty clinic to assist patients in getting timely appointments for the visits.Call or mail patients authorization, referrals and appointment in a timely manner.Informs referring provider and obtains order for additional test(s).Review on a daily basis your i2i today.Ensure that follow ups on i2i are done on a daily basis.Provide patient with a letter of their results.Follow through with necessary recalls set up in the i2i system.Data entry of all referrals are to be tracked in our PMS or i2i system, including notesEvaluates referral request for eligibility, benefit determination, preferred provider networks.Appropriate documentation according to internal policies and procedures.Works aggressively with physicians and physician office staff to obtain necessary medical information related to the referral request.Meets or exceeds Referral Department productivity targets on a weekly basis.Maintains files and records of referral activity.Assists with cross coverage with in the referral management team as assigned.Ensures integration of Referral Management activities with other areas of compliance, case management, and Quality Measures.Assist with the training of new personnel.Participate in the joint and coordinated actions of the referral coordination team.Demonstrates initiative, motivation and resourcefulness in day to day operations.Attend meetings as requested by supervisor.Performs other duties as assigned by supervisor.3. Surgery Referrals :
Calls hospital to schedule patient’s pre-operative appointment.Provides patients with clear and accurate instructions on what needs to be done.Provides patient with clear and accurate instructions on address and directions to the hospital, date and time of appointment and what department to go to.Schedules patient for pre-operative test(s) if needed.Provides patient with a copy of history and physical (H&P) and gives him / her clear instructions on what to do with the H&P.Faxes copy of H&P to the surgery department of admitting hospitals.Responsible for receipt and data entry of referrals in out PMS system.4. Tracking and Documentation :
Maintains appropriate and accurate referral log in on PMS System or i2i System : name of patient, referring provider, type of specialty referral, patient’s insurance type, manage care, PPP, etc…, date the authorization was requested and received, date of specialty appointment, date when follow-up was made to make sure patient showed up, receipt of specialty report, referral tracking number, and authorization number.Maintains log of patient grievance and status of grievance.Maintains and submits required reports to his / her supervisor in a timely manner.5. Managed Care Partnership / LAC County / i2i System :
Maintains regular and consistent communication with staff of specialty referral source(s) to ensure smooth referral process.Attends partners and / or IPA meetings to keep current with changes updates on HMO rules and regulation.Provides Center staff with updates and changes on regulations and requirements of managed care plans.Attends partners meetings to keep current with changes and updates on systems rules and regulations.6. Customer Service :
Must complete or show certificate of attendance on : Customer Service Training & Cultural SensitivityAssists in dealing with HMO member grievance and working with clinic staff to resolve them.Assists in completing patient grievance; submits reports to his / her supervisor in a timely mannerContacts appropriate Health plan staff to inform them of patient grievance.Works closely with staff or other departments to develop and implement systems that would prevent / reduce patient grievance.Provides input and participates in Customer Service activities of the Center.Utilizes and follows the Center’s established customer service standards in conducting his / her duties.Ensures that his / her co-workers follow customer service standards in conducting their duties.Must learn about all the services and programs at the Center so he / she can provide accurate information to customers.Participates in cross-selling and marketing all Center programs and services to the customers.Works collaboratively and professionally with staff from other departments.Performs function(s) and provides coverage for HMO Enrollment as needed, and as directed by his / her supervisor.Communicates and works with Members, member services, Provider Relations and management.7. Customer Relations :
Respond promptly and with caring actions to patients and employees. Acknowledge psychosocial, spiritual and cultural beliefs and honor these beliefs.Maintain professional working relationships with all levels of staff, clients and the public.Be part of a team and cooperate in accomplishing department goals and objectives.Contribute to the success of Eisner Health by participating in quality improvement.Maintain privacy of all patient, employee and volunteer information and access such information only on a need to know basis for business purposes.Comply with all regulations regarding corporate integrity and security obligations. Report unethical, fraudulent or unlawful behavior or activity.Qualifications :
Must possess a High School diploma or equivalent.At least one (1) year experience in a clinical setting.A minimum of (1) year experience in patient referral process.Knowledge of managed care plans and requirements.Knowledge of CPT and ICD Codes.Previous experience with computers and data entry.Show proof(s) of documentation of training or certification in his / her particular field.Benefits :
Low-cost Medical, Dental, and Vision Insurance with PPO & HMO optionsRobust Paid Time Off Program (23 day accrued per year)9 Paid Holidays Per YearPaid Jury Duty Time (40 hours per year)Employer-Sponsored Life and Long-Term Disability InsuranceEmployer Sponsored Chiropractic & Acupuncture Visits401k with a 3% Employer ContributionTransportation and Parking SubsidiesTuition Reimbursement ($500 per year)EEO Statement :
Eisner Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Eisner Health does not discriminate on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty, right to reproductive freedom, or status as a covered veteran.
Salary : $500
