ACHC is a Federally Qualified Health Center and licensed primary care clinic. We provide Family Medicine and Dental Care, with additional specialists in Behavioral Health, Chiropractic, Internal Medicine, Neurology, Gynecology, Pediatrics, Podiatry and Optometry. ACHC Clinics are located across Fresno, Kings and Tulare counties.
RESPONSIBILITIES
Under the direction and oversight of the Referral Program Supervisor, the Referral Coordinator is responsible for processing patient referrals, requests for authorization, referral under a provider's order and facilitating related patient follow-up. The Referral Coordinator interfaces with patients, medical staff, nursing staff, patient accounts referring/consulting agencies and support services in the resolution of issues relating to the patient care in the referral system. The Referral Coordinator collaborates with clinic management, nursing, clinician staff, and clerical staff to maintain high standards of patient care.
EXAMPLE OF DUTIES
- Process referral requests accurately and completely, documents actions and status in appropriate electronic medical records (NextGen & i2i), communicates with patients about referral information.
- Conducts and documents follow-up referrals activities for pending referrals, appointment statuses, and tracks appointment results of incoming and outgoing referrals.
- Perform other duties in regard to patient information/education as assigned by Referral Program Supervisor/Site Manager.
- Attends trainings as appropriate for job responsibilities.
- Participates in providing training and orientation of new staff as assigned.
- Communicates status of referrals to providers, patients, and staff as requested.
- Referral Coordinators must be prepared to work or fill in for Referral Coordinator staffing gaps at all Aria Community Health Center locations as assigned by Referral Program Supervisor/Site Manager including reassignment and cross training.
- Follows policy and protocol guidelines as indicated by Aria Community Health Center.
- Receive requests from referring physicians via the electronic health record, telephone or fax and strive to complete urgent referrals within a timely manner.
- Request prior authorization from insurance companies; schedule diagnostic procedures and appointments as appropriate.
- Notify patients and referring physician's office of covered benefits.
- Notify provider when reports are received, or patient did not attend appointment.
- Document each development in a timely manner, consistently and accurately in the electronic medical record.
- Participate in utilization management, quality improvement and quality management programs as directed. Comply and keep current with accreditation standards and federal, state and local regulatory requirements.
- Perform other assignments as directed.
Additional requirements:
- HIPAA compliance - Responsible for keeping abreast of and in compliance with all HIPAA regulations and requirements. Treats all member information as confidential.
- QA/QI - Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
- IT - Required to learn and use the Electronic Health Record and Practice Electronic System and its components, as required by the job functions and highlighted in the Policies and Procedures. These components include Next Gen, PMS, i2i and other electronic features, as they are developed and implemented, as applicable to work environment.
EDUCATION/EXPERIENCE
- Medical Assistant Certificate from an approved Medical Assistant program as required by the State of California preferred
- Two years of Authorizations/Referrals experience strongly preferred.
- Experience with electronic medical records and standard PC Software applications required.
- Experience in healthcare setting (Hospital, physician's office, health plan) required.
- Claims handling or customer service experience preferred.