Referrals Care Coordinator

At DAP Health, we are committed to transforming lives and advancing health equity for all. As a leading nonprofit health care provider, we deliver compassionate, high-quality care to the diverse communities of the Coachella Valley and San Diego County. Our comprehensive services range from primary care to mental health, wellness programs, and beyond, with a focus on those who are most vulnerable. Joining our team means becoming part of a passionate, innovative organization dedicated to making a meaningful impact in the lives of those we serve. If you're looking for a dynamic and purpose-driven environment, we invite you to explore the opportunity to contribute to our mission.

Job Summary:

Referral Care Coordinator plays a key role as part of the clinical team. The referral clerk is responsible for assuring continuity of care for those patients with a referral order, by coordinating timely specialty or ancillary appointments. The referral process is a multistep process, and the referral care coordinator is responsible for making sure that the process is following its course. The referral care coordinator works as a liaison between the primary care provider, insurance companies, specialty providers, diagnostic services, and patient(s). The Referral Care Coordinator is responsible for data entry of referrals information and documentation of all referral interventions.

Supervisory Responsibilities: N/A

Essential Duties and Responsibilities:

• Process referrals according to the level of urgency.
• Data entry of all new referrals into the i2i referral module; documentation of all interventions to include, date and time.
• Documents necessary information pertaining to the referral order in the patient's chart or EHR.
• Submits authorization to insurances, tracks the status of the authorization. Once approved, documents procedure approval number and authorization period in the referral tracking system.
• Coordinates between patient and specialty provider to schedule appointments. Provides special instructions if needed.
• Communicates with primary care provider to inform of any delays or barriers to care.
• Communicate with patients if there are any delays in scheduling appointments.
• Monitor's patient compliance and re-schedules appointments as needed.
• Responsible for tracking reports and making sure that all reports are received in a timely manner. Close referrals once the report is received.
• Works with the Primary Care Provider to work on re-processing authorization denials.
• Case Management of more complex cases, with the end goal of scheduling timely referral appointments.
• Manage referrals at every stage to avoid backlog.
• Collaborate with Care Coordinator Specialist to identify patients that could benefit from program enrollment due to their conditions or needs.
• Comply with referral management policy.
• Send letters to patients when unable to reach by phone; handle all returned letters.
• Handle all incoming calls for the department in a courteous manner; provide callers with an answer to their questions as best as possible.
• Seeks assistance of supervisor when unable to process all referrals to avoid backlog and the clinical consequences of delays.
• Provides quality care to the patients of DAP Health, within the scope of practice outlined by state or federal law.
• Delivers care in accordance with established standards of care and accepted community standards.
• Understands the organization's commitment to provide high quality patient care. Promotes a Patient centered environment.

Qualifications:

Minimum Qualifications (Education and Experience):

• Diploma from an approved High School or GED Equivalent.
• One year of medical field experience with an understanding of insurance and medical terminology is required.

Special Conditions of Employment:

• All staff that is presently working within a clinic is required to have a Current and Valid CPR and First Aide certification on file with the Human Resources Department. This is for clinical and administrative staff. This new license requirement is mandatory for continued employment, CPR and First Aide certification must be obtained through the American Heart Association. Internet certificates do not comply and for this reason are not valid.

Knowledge, Skills and Abilities:

• Excellent oral and written communication skills.
• Effective interpersonal skills.
• Bilingual in Arabic/Farsi required.
• Ability to manage time well.
• Ability to use office equipment i.e., copier and fax machine.
• Accuracy is essential, close attention to detail, neatness is a priority.
• Ability to use a computer, assist administrative personnel, as necessary.
• Ability to multi-task, work independently, accurately, and with minimum supervision