Referral Coordinator

Referral Coordinator plays a key role as part of the clinician team. The RC is responsible for assuring continuity of care for those patients with a referral order, by coordinating timely specialty referral process. The referral process is a multistep process, and the Referral Coordinator will work as a liaison between the PCP, Insurance carriers, specialty providers, and patient(s). The RC is responsible for data entry of referral information and documentation of all referral interventions.

BENEFITS

• Free Medical, Dental & Vision
• 13 Paid Holidays PTO
• 403 (B) retirement match
• Life Insurance, EAP
• Tuition Reimbursement
• SEIU Union
• Flexible Spending Account
• Continued workforce development & training
• Succession plans & growth within

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education & Experience

• Associates Degree or equivalent to 5 years in the healthcare setting
• Bi-lingual English/Spanish
• Proficient Microsoft Office and Excel
• Medical Terminology
• EHR- Electronic Health Records
• Strong customer service focus
• Effective verbal and written communication skills
• Teamwork orientation
• Organized and able to manage competing priorities.
• Good judgment
• Resourcefulness in problem-solving.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Performs a combination, but not necessarily all, of the following duties:
• Provides oversight of all referral/authorization, of case management and outpatient clinical care coordination functions.
• Manage and assign unassigned referrals to the appropriate Referral Coordinators and evaluate the effectiveness of RCs workload to ensure referrals are processed timely.
• Ensures compliance with regulatory requirements and application of clinical decision support criteria for care management activities deemed by Federal, State and other regulatory and accreditation agencies.
• Assemble information concerning patient’s clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
• Review details and expectations about the referral with patients.
• 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.
• Ensure PCP timely receives the specialty report and is scanned in the patient’s medical records.
• Access patient medical records and verifies eligibility via Medi-Cal/Medicare, Health Plans web portals.
• Authorization meets productivity referrals processing of an average of 50 referrals daily including a minimum of 50 follow-up actions.
• Records- requests an average of 95 specialty reports daily.
• Uses Med Point, OPTUM, eConsult, and LANES web portals for submitting authorizations.
• Modifies CPT/ICD-10 Codes and extends authorizations as needed.
• Process Urgent referrals within 24 hours of the date ordered.
• Process routine referrals within 24-72 hours from the date ordered.
• Upload specialist report in EMR within 24 hours from the date received.
• Checks Referral Helpline telephone encounters and emails daily.
• Handle high volume of incoming /outgoing calls and provide excellent customer service.
• Seeks assistance of Supervisor when unable to process all referrals or follow-ups to avoid backlog and the clinical consequences of delays.
• Notifies the Supervisor when tasks are completed before the end of the business day to assist other team members if help is needed.
• Will attend meetings and training at collaborative and partnership events in person as needed.
• Serve as clinic liaison to outside agencies and partners.
• Uses medical terminology on a regular basis for doctors and vendors.
• Interacts with entities (IPA, Health Plans, etc.) Medical Management staff including Medical Directors and St John’s Heath Services Network, Clinic Manager, and other staff.
• Acts as a Provider educator to assure that the Provider is aware of referral timeframes and communicates referral information to the patient regarding his/her condition and patient is educated.
• Performs all other related duties assigned.
• Able to cope in a “fast-paced” work setting.
• Train new staff and providers as needed.
• Assist with patient complaints.
• Reassign eConsults to appropriate providers.
• Required to work one Saturday per month or as needed.
• Assist the Referral Call Center as needed.

St. John’s Community Health is an Equal Employment Opportunity Employer