Backlog Referral Coordinator

Central Neighborhood Hlth Fdn•San Bernardino, CA

5h•Onsite

About The Position

Central Neighborhood Health Foundation is a Federally Qualified Healthcare Center (FQHC) committed to the Triple Aim: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. The Backlog Referral Coordinator is responsible for managing and processing previously unaddressed or delayed referrals to ensure timely patient access to care. This role focuses specifically on resolving referral backlogs, improving workflow efficiency, and ensuring compliance with organizational and payer requirements.

Requirements

High school diploma or equivalent required
1–3 years of experience in referral coordination, medical administration, or a related healthcare role.
Ability to handle confidential and sensitive information.
Ability to communicate effectively on the telephone.
Ability to relate to people with diverse educational, socioeconomic, and ethnic backgrounds.
Ability to handle a “call center” environment; work quickly and multitask.
Ability to exercise good judgment to handle calls appropriately.
Ability to demonstrate good customer service.
Experience working with referral backlogs or high-volume case management.
Familiarity with EHR systems and medical terminology.
Strong knowledge of insurance verification and prior authorization processes.
Excellent written and oral communication skills.
Excellent organizational, time management, and problem-solving skills.
Ability to work collaboratively with multiple health professionals in a busy and complex environment using tact, diplomacy, and discipline.
Is a team player who demonstrates a caring and compassionate commitment to the patient and their unique circumstances.
Computer literate, including word processing, medical office management system applications, and the clinic EHR.

Nice To Haves

Bilingual English and Spanish preferred.
CPR Certification preferred.

Responsibilities

Responsible for the accurate completion and processing of referral requests from CNHF PCPs as well as from other PCPs to other providers, e.g., specialists, DME, diagnostic testing, etc.
Responsible for the processing of follow-up referral requests from specialists, following the timeliness guidelines in the Policy and Procedure Manual.
Review, prioritize, and process backlog referrals in a timely and organized manner.
Ensure that phone calls are answered promptly and courteously and that the correct information is relayed to the caller as appropriate
Responsible for the upkeep of the current Provider Directory to ensure that the correct contracted providers are being referred to.
Maintenance of referral logs.
Responsible for maintaining DHS and NCQA standards and requirements.
Responsible for notifying patients of the status of their referral in a timely manner; Stat referrals in 2 hours. Urgent in 24 hours, regular in 3-4 days, mammography results in office within 7 days, and Specialist consultation reports within 30 days. To include phone call, mail, or fax as is necessary and/or appropriate.
Verify patient eligibility, insurance coverage, and authorization requirements.
File all necessary information in the patient’s charts, e.g., copies of insurance cards, X-Ray reports, lab reports, hospital notes, referrals, consult notes, etc.
Obtain prior authorizations and ensure all required documentation is complete.
Coordinate with providers, specialists, and external facilities to schedule appointments.
Communicate with patients regarding referral status, scheduling, and required next steps.
Identify and resolve issues causing referral delays or denials.
Maintain accurate and up-to-date records in the electronic health record (EHR) system.
Collaborate with clinical and administrative teams to streamline referral workflows.
Monitor and report progress on backlog reduction and turnaround times.
Ensure compliance with HIPAA and organizational policies.
Act as a patient liaison between the UM/QM Departments and the Health Plans to help the patient access care more readily.
Display a friendly, professional attitude with patients, other staff, and the Physicians.
Keep patient records confidential.
Perform other related duties as assigned or requested.