Referral Coordinator Lead

Caring Health Center•Springfield, MA

About The Position

The Lead Referral Coordinator supports the Supervisor of Medical Referrals in carrying out the department’s vision and expectations. When the supervisor is absent, the Lead provides oversight, guidance, and direction, and assists with staff evaluations, corrective actions, training, and development. The role also serves as the primary liaison among the primary care physician (PCP) team, patients, and external referral specialists. It coordinates specialist appointments and insurance authorizations, and tracks, monitors, and retrieves referral results in compliance with insurance requirements. The Lead manages referral department data and reporting, identifies trends and gaps, and develops improvements to department workflows and performance. The role maintains accessible, current electronic workflows and training materials, conducts and records regular staff training, and supports compliance with HRSA 18 Core Requirements, CMS regulations, other applicable regulatory bodies, and the agency’s strategic vision. The position requires prolonged computer and desk work, occasional standing and moderate physical activity, and may involve long and arduous hours. It may also involve exposure to adverse outdoor environmental conditions.

Requirements

Associate degree or two years of referral experience.
Extensive knowledge of and experience with the full referral process.
Ability to establish and maintain effective working relationships with employees, patients, outside-agency representatives, and the public.
Professional manner and appearance.
Excellent verbal and written communication skills.
Strong computer skills and ability to master the EPIC OCHIN electronic medical record.
Current HIPAA training.
Ability to work at a computer workstation.
Ability to sit and type for prolonged periods and to stand for prolonged periods.
Ability to perform moderate activities including climbing stairs, bending, stooping, reaching, and lifting up to 20 pounds at times.
Ability to work long and arduous hours from time to time.

Nice To Haves

Medical Assistant training.

Responsibilities

Review referrals and PCP notes; verify and update patient insurance information, address, and phone number.
Work with PCPs to ensure required information is available for referral processing.
Send pertinent referral information to specialists, observing HIPAA’s minimum-necessary standard.
Schedule external specialist appointments according to insurance type and PCP direction.
Submit and obtain prior authorizations as required by the service and insurance.
Inform patients of appointment-booking options and actions they may need to take when insurance is unavailable or authorization is denied.
Consult providers about referral status as needed.
Document referral details and actions in the electronic health record, including appointment location, specialty office, date, and special instructions.
Notify patients of scheduled appointment information by mail, phone, or WELL.
Retrieve specialist notes and reports from fax and other systems, upload them to the EHR, notify the provider, and close referrals.
Follow up with specialty practices on outstanding reports.
Run reports on open and booked referrals, identify items requiring action, and communicate status to management.
Answer calls and inquiries or redirect them appropriately; regularly check and address referral voicemails.
Perform general office duties requiring communication and organizational skills, and provide high-quality customer service.
Maintain patient privacy and confidentiality and adhere to HIPAA regulations.
Support the agency’s accountable care organization partnership by focusing on high-quality, high-value patient care.
Review and manage department data analytics, generate reports, identify trends and gaps, and implement improvement systems.
Implement or incorporate a transparent, clear, and concise performance dashboard for coordinators and the department.
Provide weekly data-driven reports on department performance, setbacks, achievements, and concerns.
Maintain a complete, current electronic workflow, including videos, in a shared cloud-based location accessible to referral staff in real time.
Conduct and record regular training to promote standardization and efficiency.
Identify training gaps and implement audits, assessments, training plans, and benchmarks to close them.
Identify opportunities to improve the department and ensure compliance with HRSA 18 Core Requirements, CMS regulations, other regulating bodies, and the agency’s strategic vision.
Foster a positive environment of accountability and excellence.
Perform other duties as assigned.