Referral Coordinator-SGH

Presbyterian System Services • Socorro, TX

12d • Onsite

About The Position

The Referral Coordinator navigates complex requests from referring providers and their offices, primarily by phone, and develops positive working relationships with them. The role responds to requests and concerns with diplomacy and professionalism, using knowledge of organizational resources and appropriate escalation pathways. It coordinates incoming referrals from receipt through completion, schedules referrals and specialty or radiologic procedures, and helps referring offices understand prior authorization requirements and processes. The coordinator also monitors in-baskets and reports for overdue results, waitlisted appointments, recalls, and related items, and supports accurate, efficient scheduling in the home department.

The coordinator works with providers, testing departments, health plan representatives, program departments, and Business Development to facilitate access, referral processing, and provider-to-provider communication. The role requests relevant medical records, ensures required testing is ordered and scheduled, and informs the ordering clinician when access restrictions prevent scheduling as ordered. The position is full-time, non-exempt, and based at PMG - Socorro, with a day shift.

Requirements

• High school diploma or equivalent.
• At least 18 months of experience in a medical office setting with significant physician interaction.
• Proficiency in prior authorization, certification, and referral processes.
• Pass the EPIC competency for Registration upon completion of the Epic Clerical Training class.
• Short-term training in medical terminology.
• Working knowledge of CPT and ICD-10 coding.
• Pass an annual competency exam for all areas of responsibility.
• Strong organizational and multitasking skills.
• Significant customer service skills.
• Ability to function under pressure while maintaining professionalism.

Responsibilities

• Provide an exceptional experience for providers and referring-provider offices using CARES, AIDET, and EPE tools.
• Ensure communications with providers and patients occur in a timely manner.
• Communicate with referring providers and their offices to schedule referrals, answer questions, and arrange provider-to-provider communication as needed.
• Address and attempt to resolve concerns and requests in the moment using available resources and appropriate escalation.
• Coordinate with departments throughout the program to gain access for referrals.
• Follow up with referring providers about the status of referrals or requests.
• Maintain knowledge of program operations and processes to guide referring providers, answer questions about potential referrals, and perform appropriate hand-offs.
• Coordinate with the Business Development partner to collect feedback from referring offices.
• Manage conflict and request supervisor assistance when needed.
• Foster effective relations with patients, the public, and providers by listening, responding, and escalating when appropriate.
• Work with program providers, testing departments, and health plan representatives to facilitate access for referrals and members.
• Facilitate provider-to-provider communication as requested.
• Coordinate incoming referrals from receipt through completion.
• Enter faxed referrals into the EHR.
• Guide and assist referring offices through prior authorization request requirements and processes.
• Use knowledge of surgical and procedural scheduling workflows to prepare and hand off referrals appropriately.
• Ensure relevant medical records are requested.
• Ensure required testing for referrals is ordered and scheduled.
• Inform the ordering clinician when access or another restriction prevents scheduling as ordered.
• Perform advanced scheduling for specialty or radiologic procedures; recognize payer requirements and obtain prior authorization, certification, or referrals for visits and procedures.
• Scrub schedules for accuracy and efficiency in the home department.
• Monitor in-baskets and reports for overdue results, waitlisted appointments, recalls, and related items.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Short-term disability insurance
• Long-term disability insurance
• Group term life insurance
• Optional voluntary benefits
• Employee Wellness rewards program, with opportunities to earn gift cards through wellness activities

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED