Referral Coordinator

Summary: Responsible to coordinate and complete specialty and diagnostic services in a timely and efficient manner. This position is also responsible for tracking the receipt and completion of specialty and diagnostic referrals including but not limited to phone calls and letters to non-compliant patients.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Coordinate all aspects of a specialty and/or diagnostic referral in a timely manner when requested by Grace Health providers.
• Verify insurance coverage and obtain prior authorizations for services to be rendered as required by individual insurance plans.
• Ensure that the specialist accepts the patient’s insurance plan.
• Assemble referral paperwork and requested medical information and submit to the specialty office as needed.
• Communicate referral information to the patient and providers.
• Document appointment or preauthorization information in Nextgen EMR or in an electronic log of all referrals.
• Provide excellent customer service to both internal and external customers. 
• Establish and maintain professional relationships with all staff.
• Inform leadership of authorization or referral concerns, back logs, or insurance issues.
• Routinely generate a NextGen Referral report or work electronic log of ordered referral requests.
• Verify that the office has received the diagnostic or specialty report when ordered.
• Coordinate with appropriate sites to obtain diagnostic results or specialty referral report if the information has not been received.
• Complete the referral order in the Order Management section of Next Gen or indicate complete on the electronic log indicating the date that the referral results were received.
• Conduct patient outreach when the patient has not been compliant with a provider’s order; one phone call and one sent letter.
• Document patient’s non-compliance in Next Gen Order Management section and Manage Selected Referral or on the electronic log.
• Work with other members of the health team when patients request that their referral be rescheduled.
• Other duties may be assigned.

OTHER ESSENTIAL DUTIES and RESPONSIBILITIES:

• Grace Health recognizes that managing patient care is a team effort that involves clinical and non-clinical staff.  All employees must embrace a team-based approach to patient care and understand that each role is important to our success. 
• Team members must demonstrate excellent team communication and coordination to provide quality patient care.
• Care coordination includes communicating with community organizations, health plans, facilities, and specialists.
• Care team members understand and embrace the concept of population management and proactively address the needs of patients and families served by this practice. 
• Team members must demonstrate skill and knowledge related to effective communication with vulnerable patient populations.
• Team members must participate in Continuous Quality Improvement activities within the organization to ensure patients receive high quality care.
• All team members will be involved in the process of improving quality incomes.
• Team members will participate in the review and evaluation processes of practice performance and help to identify opportunities for improvement.
• Team members will participate in Grace Health's advocacy program.

GENERAL DUTIES:

• Follows policies and procedures of the office, including administrative, clinical, quality assurance, and personnel
• Maintain good attendance (daily, meetings, and other assignment tasks)
• Maintain timely documentation of all work assignments
• Maintain patient confidentiality
• Routinely keep supervisor informed about attendance and job assignments
• Flexible in being able to multitask
• Work effectively and at an efficient pace
• Work cooperatively with physicians, administration, and peers

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to assist in advancing Grace Health’s mission and 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.

SKILLS:

• Pleasant personality and professional demeanor
• Cooperative attitude-Flexible
• Detail Oriented
• Able to work with minimal supervision
• Highly organized work habits with ability to prioritize
• Intermediate computer skills with Microsoft Word and Excel
• Familiar with Electronic Medical Record

EDUCATION and/or EXPERIENCE: 

Must have completed high school or equivalent.  Must have past experience with Referrals and Authorizations.  Prefer 1-year Medical Office experience. Prefer RMA or CMA.

Grace Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.