Referral Coordinator
JOB SUMMARY
The role of the Referral Coordinator is to facilitate consistency of information shared across practices to promote care coordination and effective member co-management for behavioral and non-behavioral practitioners.
DUTIES & RESPONSIBILITIES
The Referral Coordinator job description is intended to point out major responsibilities within the role, but it is not limited to these items.
Prioritizes assigned patient cohorts to ensure specialty referral completion and ensures stat and expedited referrals are completed based on timeliness standards.
Schedules patients (Preferred Providers List of Specialist) and notifies them of appointment information, including, date, time, location, etc.
Ensures missed specialty appointments are rescheduled and communicated to the physician/clinician.
Ensures specialist notifications of referral status.
Completes exchange of information by retrieving and ensuring upload of specialty consultation and follow up notes.
Completes documentation based on standardized documentation; to include location, notification of specialist, patient notification, status of appropriateness reviews.
Enters all Inpatient and Outpatient elective procedures in EMR and contacts specialists for post-procedure referral needs.
Follows up on all Home Health and DME orders to ensure patient receives services ordered.
Completes appropriateness review based on clinical protocols and appropriately refers to Nurse or Medical Director
Addresses referral-based phone calls for Primary Care Physicians panel and completed phone messages timely.
Adheres to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned.
EDUCATION AND PROFESSIONAL EXPERIENCE
(Licensures AND Certifications)
High School Diploma
Minimum 2 years of experience in medical management.
Capacity to interpret health plan benefit decisions.
Certification as a Medical Assistant preferred.
PROFESSIONAL COMPETENCIES
(List professional knowledge, attitude, and skills required to work in the job)
High level of critical thinking and problem-solving skills
Strong work ethic and overall positive attitude
Effective communication skills including verbal and written.
Ability to manage time effectively, understand directions, and work independently in a fast-paced environment.
Demonstrated flexibility, organization, and self-motivation.
Highly adaptable to change.
WORK ENVIRONMENT
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required.