Referral Coordinator

Summary

The Referral Coordinator is responsible for the effective management of all incoming specialist referrals.

Duties and Responsibilities

1. Responsible for coordinating and processing of all patient referrals for specialty services.
2. Utilizes a high degree of accuracy in obtaining and verifying that all registration data, demographic and insurance information is correct and up to date.
3. Acts as liaison between Community Medical Group and other healthcare providers while exhibiting and utilizing a high level of customer services skills.
4. Performs eligibility checks on members as necessary by telephone or electronically as appropriate.
5. Follows procedures for proper authorization and processing of all referral services including obtaining approval from our medical director.
6. Supports physicians and patients in synchronizing appointments, authorizations and tests taking place in different clinics.
7. Sets up appointments and transportation as necessary.
8. Contacts the patient on a timely basis for all scheduling requirements.
9. Communicates with patients to ensure follow-through with referrals.
10. Ensures strict confidentiality of all health records, member information and follows HIPAA guidelines.
11. Coordinates pre-admission testing requirements with clinic personnel and patients.
12. Completes all administrative functions related with referral activities in an efficient manner.
13. Enters all referral, hospital, outpatient and other patient specialty health service authorizations into the computer system following CMG policies and procedures.
14. Responsible for monitoring all referral reports not received and follow-up in a timely manner.
15. Performs duties in honest and ethical manner.
16. Perform other duties as assigned.

Qualifications

1. Education/Experience:
2. Must have High school diploma or equivalent.
3. Prior experience in a clinical setting
4. MS Office programs experience.
5. Medical Assistant training or certification preferred.
6. Knowledge of medical terminology and CPT, HCPCS and ICD coding preferred.
7. Knowledge of Electronic Health Records (EHR) preferred

Skills:

1. Use relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
2. Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines and standard accepted practices
3. Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
4. Ability to work with individuals within and outside the organization, in professional and courteous manner.
5. Must develop constructive and cooperative working relationships with others.
6. Understand written sentences and paragraphs in work related documents.
7. Strong ability to use independent judgment and initiative.
8. Organized and able to manage competing priorities.
9. Resourcefulness in problem solving.
10. Actively look for ways to help people.
11. Strong written and verbal communications skills
12. Knowledge of medical terminology
13. Must be extremely detail oriented.
14. Strong organizational and interpersonal skills.
15. Knowledge of EHR
16. Bilingual skills preferred (English/Spanish or English/Creole)
17. Must develop constructive and cooperative working relationships with others.