Referral Coordinator

Description

OVERVIEW:

The Referral Coordinator will work closely with medical providers and nursing staff to transfer information and obtain insurance authorization to transition Plymouth Primary Care patients to specialty appointments with detail and accuracy. 

ESSENTIAL JOB DUTIES:

• Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. This tracking may use an EMR.
• Ensure complete and accurate registration, including patient demographic and current insurance information.
• Assemble information concerning patient’s clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
• Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, and prognosis. Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians.
• Review details and expectations about the referral with patients.
• Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
• Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns. May assume advocate role on the patient’s behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
• Identify and utilize cultural and community resources, Establish, and maintain relationships with identified service providers.
• Ensure that referrals are addressed in a timely manner.
• Remind patients of scheduled appointments vis mail or phone.
• Ensure that patient’s primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.

Requirements

RESPONSIBILITIES/KNOWLEDGE/SKILLS:

• Personality and demeanor to deal with the public and assist ill, older or distraught patients with specialty referrals.
• Basic office skills such as typing and filing.
• Good Organizational Skills
• Ability to handle a fast p-paced environment and prioritize tasks based on importance.
• The ability to work well with others (be a team player)

QUALIFICATIONS:

• High School Diploma/GED required (Associate Degree Preferred)
• Strong customer service focus
• Effective verbal and written communication skills
• Teamwork Orientation
• Organized and able to manager competing priorities
• Good judgment
• Resourcefulness in problem solving able to take and follow through with delegated tasks and accountability

PHYSICAL REQUIREMENTS:

• Prolonged periods of sitting at a desk and working on a computer
• Lengthy periods of time on the phone with Insurance Companies
• Lengthy phone calls with physician specialty offices to schedule appointments.
• Prolonged periods of constant telephone interruptions
• Must be able to lift up to 25 pounds at a time.