Job Description The Referral Coordinator is responsible for referral operations, establishing and standardizing systems and procedures for the distribution and use of health information throughout the organization, coordinating and referral functions with all other departments. The Referral Coordinator works with individuals within the organization as well as outside of the organization to coordinate important health related specialist visits for the patient and is expected to be meticulous in managing and tracking such information.
Essential Duties and Responsibilities 1. Ensures current referral policies and workflows are standardized, accurate and up to date.
2. Prioritizes and tracks referrals by their urgency and addresses them in a timely manner.
3. Participates in the selection, orientation and training of referral personnel.
4. Ensures complete demographic, insurance information and appropriate/pertaining clinical information is sent to referred specialists.
5. Contacts insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as, history, diagnosis and prognosis to insurance companies if deemed necessary to prove medical necessity of services.
6. Reviews details and expectations about the referral with both ordering providers and patients. Requests new referrals to be ordered when applicable.
7. Develops and implements systems as required by EMR functionality and/or regulatory agencies.
8. Identifies and utilizes community resources; establishes relationships with servicing providers and personnel.
9. Point of contact for patients and specialists for any questions or rising concerns. Assist in problem solving potential issues related to their referral due to language or social barriers. If unable to help, assist in finding the right point of contact to further help.
10. Other functions as directed by the Supervisor.
Qualifications
Experience with referrals in healthcare preferred
Experience with Electronic Health Records required
Proficient knowledge of insurance policies. CPT and ICD-10 knowledge.
Computer literate and proficient in MS Office.
Excellent critical thinking and decision-making skills.
Strong customer service skills, professional attitude, clerical expertise, IT competence, and strong organizational skills.
