SUMMARY:

The Referral Coordinator works under the direction of the Patient Access Supervisor. The Referral Coordinator will coordinate with providers, staff and patients to ensure clinician referrals are completed and processed in a timely manner based on clinically accepted guidelines. This will be accomplished by reviewing specialist guidelines for referrals, contacting appropriate providers, patients, staff and outside agencies as needed, and tracking these results on an individual and group basis through the referral system. The Referral Coordinator is responsible for ensuring internal and external clients are provided with exceptional customer service. Duties include, but are not limited to, determining and verifying patient program/insurance eligibility requirements, providing patient appointment scheduling, handling scanning/inputting required patient information, providing referrals and program services, and other duties as assigned.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. Supports and implements the organization’s vision, mission and values.
2. Determines priorities and method of completing daily workload to ensure that all responsibilities are carried out in a timely manner.
3. Performs all job functions in a professional and courteous manner. This includes answering all phone calls and emails timely and providing excellent customer service to internal and external customers.
4. Fosters and promotes a culture of service excellence and accountability.
5. Performs timely and accurate patient registration and patient flow tracking in accordance with health center procedures. Determines and verifies patient program/insurance eligibility requirements for assuring proper.
6. Schedules, confirms and cancels appointments, coordinates walk-in patients, follows up with providers for canceled/no show appointments. Utilizes the appointment template to meet or exceed productivity standards.
7. Responds to incoming telephone calls in a timely, courteous manner. Screens and forwards calls, as appropriate. Documents and forwards messages when required.
8. Reviews referrals for administrative completeness and research covered benefits prior to processing.
9. Determines patient eligibility for services and arranges and schedules medical appointments for referred care.
10. Provides general instructions to patients and ensures patients have necessary documentation for referred health services.
11. Organizes and researches patient records, extracts needed information, and reviews records for referral results within established guidelines.
12. Requests medical records and ensures arrival of medical records prior to appointment(s). Initiates and locates patient medical records as needed.
13. Obtains documentation as requested by healthcare providers (test results, or documentation not yet filed in records).
14. Ensures referral results are returned to the referring provider and to the medical record within required timelines. Assists with follow up, written or verbal, as necessary.
15. Participates in quality and utilization activities that may include the tracking, completion and submission of reports.
16. Handles telephone calls in a highly professional manner. Responds in a prompt and accurate manner to all requests and inquiries. Demonstrates ability to problem solve and perform critical thinking. Adheres to all requirements regarding patient privacy and confidentially.
17. Demonstrates the ability to make decisions and exercise sound judgment. Demonstrates the ability to set priorities, and complete assigned duties in a timely manner. Understands the needs of others in relation to his/her responsibilities and uses good judgment when responding to their requests.
18. Prepares reports clearly, neatly and accurately with complete documentation in a timely manner. Follows all work through to completion in a timely, efficient manner in accordance with his/her assigned duties and responsibilities. Performs work in an honest and ethical manner with sensitivity to those affected by the decisions made. Consistently treats coworkers, vendors and the public, etc., with respect, courtesy, cooperation, and professionalism.
19. Complies with organizational policies and procedures.

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 ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION/EXPERIENCE:

1. High School diploma, GED, or equivalent work experience is required.
2. Ability to maintain confidentiality.
3. Must have accurate attention to detail.
4. Knowledge of medical terminology required.
5. Data entry experience and use of electronic health records desired.
6. Three years customer service experience required.
7. Bilingual (Spanish) a must.
8. Medical Assistant Certification preferred.

LANGUAGE SKILLS:

Ability to read and interpret documents, such as policies and procedures, benefits information, benefit surveys, board minutes, routine mail, simple contracts, and instruction manuals. Ability to compose routine reports and correspondence. Ability to speak effectively with employees, visitors and management.

MATHEMATICAL SKILLS:

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, and apply concepts of basic algebra and geometry.

REASONING ABILITY:

Ability to exercise common sense in carrying out instructions furnished in written, oral, or diagram form and in other daily situations that arise. Ability to deal with problems involving several concrete variables in standardized situations. Ability to make decision and execute timely in order to produce a positive outcome.

OTHER SKILLS AND ABILITIES:

Ability to use computer system to perform work.

JOB KNOWLEDGE AND SKILLS:

1. Demonstrates ability and flexibility to work in other areas of the organization as needed.
2. Performs work in adherence to company’s policies and procedures.
3. Demonstrates required knowledge, skills, and education for job functions.
4. Performs all job functions in a professional, courteous and timely manner while demonstrating and promoting positive customer service skills.
5. Adjusts schedule in conjunction with the process of departmental scheduling and departmental need. Performs duties and tasks with minimal supervision. Identifies problems and opportunities to improve the quality of department services and provides suggestions to the Manager. Seeks guidance when necessary to effectively perform duties.
6. Demonstrates proficiency in basic computer applications.
7. Maintains and promotes a safe work environment.

1. Uses discretion and judgment in handling sensitive or confidential information.
2. Performs work in an honest and ethical manner.
3. Adapts well to changes in work requirements.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to use hands to finger, handle or feel and reach with hands and arms. The employee frequently is required to stand, walk, and sit. The employee is occasionally required to climb or balance, stoop, kneel, crouch or sit. The employee must frequently lift and/or move up to 10 pounds and occasionally life and/or move up to 30 pounds. The employee is occasionally required to ascend and descend one flight of stairs. Specific vision abilities required by the job include close vision, color vision, and ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is often moderate. However, there are many times when there is a high ambient background noise of phones and multiple conversations. Must be able to screen out the background noise to concentrate on the work at hand.