Referral Coordinator

Job Summary  

Performs a wide range of administrative duties to include referral processing, patient registration, verification of benefits, insurance authorizations, patient appointment scheduling, communication with referral sources and other tasks assigned. 

Essential Job Functions  

Maintains ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. This tracking may use an EMR database.  

Ensures complete and accurate registration, including patient demographic and current insurance information.  

Assembles information concerning patient's clinical background and referral needs. Per referral guidelines, provides appropriate clinical information to specialist.  

Contacts review organizations and insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis, and prognosis. Provides specific medical information to financial services as appropriate to process referral.  

Reviews details and expectations about the referral with patients.  

Assists 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).  

System navigator and point of contact for: patients and individuals who have consent and direct access to patient information and can ask questions.  

In some circumstances, may assume an advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient promptly.  

Identifies and utilizes cultural and community resources. Establishes and maintains relationships with identified service providers.  

Ensures that referrals are addressed promptly, all referrals should be processed by the end of 90 days from initiation.  

Reminds patients of scheduled appointments via mail, phone, or text.  

Processes requests for medical records release and maintains appropriate logs, etc.  

Performs all other related duties as assigned. 

Minimum Required Education, Experience & Skills  

• High school diploma or GED equivalent. 

• Strong customer service focus. 

• Effective written and oral communication skills. 

• Teamwork orientation. 

• Organized and ability to manage competing priorities. 

• Knowledge of medical terminology. 

• Knowledge of ICD-10 and CPT coding. 

• Expert in computer literacy in electronic health record. 

• Ability to react calmly and effectively in emergency situations required. 

• Basic mathematical skills.  

• Safe work practices in a clinic setting. 

• Able to follow through with delegated tasks.  

Preferred Education, Experience & Skills 

• At least 5 years in a medical related customer service role. 

• Bilingual in English/Spanish preferred but not required.  

Physical & Mental Requirements: (check all that apply)  

• Required immunizations and vaccinations. 

• Ability to lift to 50 pounds.  

• Ability to push or pull heavy objects using up to 100 pounds of force.  

• Ability to stand or sit for extended periods of time.  

• Ability to use fine motor skills to operate equipment and/or machinery.  

• Ability to properly drive and operate a vehicle.  

• Ability to receive and comprehend instructions verbally and/or in writing.  

• Ability to use logical reasoning for simple and complex problem solving. 

• Occasionally requires exposure to communicable diseases or bodily fluids. 

• Occasional travel for clinic activities may be required (ex. InnovaCare meetings or training).