Referrals - Referral Coordinator I

Unicare Community Health Center Inc, Recruiter•Hesperia, CA

143d•$25 - $30

About The Position

Referral Coordinator I coordinates care between medical providers and specialists to ensure patients receive appropriate care. The role processes referrals, completes the referral life cycle, and works with clinicians, patients, specialists, insurers, and review organizations to meet clinical and prior-approval requirements. It maintains referral tracking and documentation, ensures patient registration and insurance information are accurate, and keeps primary care charts current with relevant specialist, hospital, emergency-room, and community-care information. The coordinator explains referral details to patients, helps address financial, social, and health-system barriers, and serves as a contact and navigator for patients and families. The role may advocate with insurance carriers to obtain timely approval for necessary services or supplies, connect patients with cultural and community resources, and remind patients of scheduled appointments. The position also requires compliance with confidentiality, regulatory, organizational, and professional standards, and may involve travel to other clinic locations for cross-coverage support.

Requirements

High school diploma or GED.
One to two years of referral experience.
Bilingual in English and Spanish.
Reliable transportation.
Excellent people skills and ability to partner with a dynamic leadership team.
Integrity, credibility, and commitment to the organization’s mission.
Ability to be flexible, multitask, work in an ambiguous and fast-moving environment, and set priorities while driving toward clarity and solutions.
Strong customer-service focus.
Effective verbal and written communication skills.
Teamwork orientation.
Organization and ability to manage competing priorities.
Good judgment and resourcefulness in problem solving.
Ability to accept delegated tasks and follow through with accountability.
Ability to meet the physical requirements, including pushing and pulling objects up to 25 pounds; frequent wrist, hand, and finger dexterity; full range of body motion including twisting, pushing, and pulling; lifting and carrying up to 25 pounds; reaching, bending, stooping, handling objects, talking, hearing, and seeing.
Ability to work in conditions involving non-ionizing radiation (microwaves) and hazardous exposure, including chemicals such as latex and infectious hazards.

Nice To Haves

Medical assistant certification preferred.

Responsibilities

Process referrals submitted by health care providers in all referral queues.
Complete the referral life cycle within identified time periods, including submission, approval, patient notification, follow-up, and securing medical records.
Adhere to insurance requirements and communicate with clinicians about clinical care needs related to referrals.
Track referrals and maintain appropriate documentation to promote team awareness and patient safety, potentially using an EHR database.
Ensure patient registration is complete and accurate, including demographic and current insurance information.
Assemble information about patients’ clinical backgrounds and referral needs, and provide appropriate clinical information to specialists according to referral guidelines.
Contact review organizations and insurance companies to meet prior-approval requirements, presenting necessary medical information such as history, diagnosis, and prognosis.
Provide specific medical information to financial services to help maximize reimbursement to the hospital and physicians.
Review referral details and expectations with patients.
Help patients address issues related to the health care system and financial or social barriers, including requesting interpreters, transportation services, or prescription assistance as appropriate.
Serve as a system navigator and point of contact for patients and families, responding to questions and concerns.
When appropriate, advocate with carriers to obtain timely approval for necessary patient supplies or services.
Identify and use cultural and community resources and establish and maintain relationships with service providers.
Ensure referrals are addressed in a timely manner.
Remind patients of scheduled appointments by mail or phone.
Keep the patient’s primary care chart up to date with information about specialist consults, hospitalizations, ER visits, and community organizations related to their health.
Perform other duties as assigned, including related tasks directed by the Referral Supervisor to achieve organizational and programmatic goals.
Adhere to the dress code and maintain a neat, clean appearance.
Maintain patient confidentiality.
Report to work on time and as scheduled.
Maintain compliance with state, federal, and local regulatory requirements.
Represent the organization positively and professionally and comply with policies and standards for ethical business practices.
Communicate the organization’s mission, ethics, and goals.
Participate in performance improvement and continuous quality improvement activities.
Maintain reliable transportation and travel to other clinic locations as needed for cross-coverage support.