Referrals - Referral Coordinator

Job Summary

Referral Coordinator I is responsible for coordinating the care between the medical providers and the specialists to ensure that the patients are getting the appropriate care.

Duties/Responsibilities:

• Responsible for processing the referrals submitted by health care providers in all referral queues.
• Must complete the referral life cycle, submit-approve-notify patient-follow-up-secure medical records within the identified time periods.
• Adhere to insurance requirements and closely communicate with clinicians for all clinical care needs to process a referral.
• Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. This tracking may use an EHR database.
• Ensure complete and accurate registration, including patient demographic and current insurance information.
• Assemble information concerning patients clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
• Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, and prognosis. Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians.
• 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).
• Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns. May assume advocate role on the patients behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
• Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.
• Ensure that referrals are addressed in a timely manner.
• Remind patients of scheduled appointments via mail or phone.
• Ensure that patients primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.
• Any and all other duties as assigned.

Non-Essential Functions

• As directed by the Referral Supervisor, performs other related and/or necessary tasks to achieve organizational and programmatic goals and objectives.

Professional Requirements

• Adhere to dress code, appearance is neat and clean.
• Maintain patient confidentiality at all times.
• Report to work on time and as scheduled.
• Maintain regulatory requirements, including all state, federal and local regulations.
• Represent the organization in a positive and professional manner at all times.
• Comply with all organizational policies and standards regarding ethical business practices.
• Communicate the mission, ethics and goals of the organization.
• Participate in performance improvement and continuous quality improvement activities.
• Must have reliable transportation.

Qualifications

• High school diploma or GED required.
• Medical assistant certification preferred.
• One (1) to two (2) years referral experience.
• Bilingual in English/Spanish required.

Knowledge, Skills, and Abilities

• Excellent people skills, with an ability to partner with a dynamic leadership team.
• Possess personal qualities of integrity, credibility, and commitment to corporate mission.
• Flexible and able to multitask; can work within an ambiguous, fast-moving environment, while also driving toward clarity and solutions; demonstrated resourcefulness in setting priorities.
• 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
• Able to take and follow through with delegated tasks and accountability

Physical Requirements and Environmental Conditions

• Pushing and pulling objects up to 25 lbs.
• Frequent wrist, hand and finger dexterity to perform fine motor function without tremor.
• Full range of body motion including twisting body, pushing, and pulling.
• Position requires light to moderate work with 25 lb. maximum weight to lift and carry.
• Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing.
• Reasonable accommodation will be made to enable individuals with disabilities to perform the essential functions of the position.

Working Conditions

• Non-Ionizing Radiation (microwaves)
• Hazardous Exposure (chemical [E.G. Latex] and infectious)

Work Schedule

• You will generally be scheduled to work each day Monday through Friday, with starting times each day varying between 8:00 a.m. and 9:00 a.m. and ending time between 5:00 p.m. and 6:00 p.m., as required to meet the operational needs of the company. There will be occasional Saturdays as needed.
• You will need to travel to other clinic locations as needed for cross coverage support.

Our Mission

The mission of Unicare is to be a community health care organization that treats everyone with dignity, respect and cultural sensitivity to help create an environment in which all can prosper.