Referral Coordinator

WELLSPACE HEALTH•Sacramento, CA

31d•$25 - $32•Onsite

About The Position

WellSpace's mission is "achieving regional health through high quality comprehensive care." We believe that everyone deserves to be seen, no matter who you are, where you come from, where you work or what place you call home. At WellSpace, we see you! We are driven to serve the whole person through comprehensive, integrated care, spanning medical, dental, behavioral health, and supportive services across the region. We do this by building a team of exceptional colleagues who are dedicated to our mission and becoming part of the communities we serve. As the region's largest Community Health System, WellSpace utilizes a Confluence Model to integrate an internal network of healthcare modalities, including Federally Qualified Health Centers (FQHC), Certified Community Behavioral Health Center (CCBHC), Drug Medi-Cal and Specialty Mental Health programs, California's second largest 988 Suicide and Crisis Lifeline Center, an independent Risk Bearing Organization (WellSpace Nexus), and more into a seamless confluence of care. To ensure the highest quality of care, WellSpace is accredited by the Joint Commission for Ambulatory Care, Behavioral Health and as a CCBHC. Further, it is certified by the Joint Commission as a Primary Care Medical Home and a Behavioral Health Home. WellSpace's crisis programs are accredited by the American Association of Suicidology and the International Council for Helplines. The Referral Coordinator must collect a variety of information in an extremely accurate manner in a fast paced environment, while maintaining patient confidentiality. Must be able to use various complex tools to register and schedule patients. Must be highly skilled in verbal and written communication.

Requirements

High School Diploma or equivalent.
Communicate clearly and concisely, both verbally and in writing and demonstrate a high level of listening skills.
Excellent interpersonal skills.
Exceptional customer service experience including active listening, problem solving, and the ability to remain calm in emotional or stressful situations.
Strong administrative skills with attention to detail.
Commitment to HIPAA and ability to abide by standards of professional ethics and maintain confidentiality.
Computer (PC) literate in Microsoft Word, Excel, Powerpoint, Outlook email and database software.
Database software and Electronic Health Records Systems experience, NextGen preferred.
Requires understanding of health insurance concepts and requirements, including HMO, PPO, Medicare, Medi-Cal, and other federal and state agency programs.
Requires knowledge of medical and billing terminology (ICD-9/10 and CPT codes).
Work flexible schedule when needed.
Able to take and follow through with delegated tasks and accountability.
Demonstrated commitment to the provision of services for the underserved and sensitivity working with a variety of people from low-income populations, with diverse educational, lifestyle, ethnic, and cultural origins; disabled, homeless, substance users, HIV (AIDS) infected, and/or physiologically impaired.
Adherence to infection control procedures, including but not limited to, standard precautions of temperature monitoring, hand washing, symptom self-monitoring, masking and social distancing.
Assist and support the Center/Department/Program to meet standards of High Reliability.

Nice To Haves

Medical Assistant training/certification preferred.
Two plus years related experience preferred OR an equivalent combination of education and experience sufficient to successfully perform the essential duties of the job.
Fluency in additional languages preferred.

Responsibilities

Receives referrals, verifies for completeness and appropriateness, and communicates with referral sources to obtain additional information as needed.
Processes and tracks referrals and diagnostic orders.
Keeps accurate patient records and verifies insurance requirements.
Obtains and completes all necessary insurance authorization as appropriate in a timely and thorough manner to maximize quality of patient care, with knowledge of insurance benefits, in/out of network requirements, pre-determination services, and medical necessity.
Maintains ongoing tracking and appropriate documentation on referrals keeping status and outcome of requests to promote and warrant patient care.
Ensures complete and accurate registration, including patient demographic and current insurance information.
Assembles information concerning patient's clinical background and referral needs.
Per referral guidelines, provides appropriate clinical information to specialist.
Contacts organizations and insurance companies to ensure prior approval requirements are met.
Presents necessary medical information such as history, diagnosis and prognosis.
Reviews details and expectations about the referral with patients.
Assists patients in problem solving potential issues related to the Health Care System, financial or social barriers.
Be the system navigator and point of contact for patients and families, having direct access for asking questions and 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.
Identifies and utilizes cultural and community resources.
Generates and electronically transmits the summary of care document to the specialist prior to patient appointment for all care transitions.
Establishes and maintains relationships with identified service providers.
Communicates with community organizations, health plans, outside facilities, and specialists to ensure that referrals are addressed in a timely manner.
Coordinates specialty and diagnostic appointments with patients and specialists/facilities.
Schedules patients for initial specialty referral appointments.
Follows protocols and WellSpace Health Guidelines provided for handling referrals and directing effectively using the procedures given.
Communicates with team mates and management if there is a lack of understanding on procedures.
Participates in meetings as required.
Performs other tasks as assigned.

Benefits

Regionally competitive salary
Above average health benefits at reduced costs
Company paid life insurance & long-term disability insurance
Additional voluntary retirement plan with company match and no vesting schedule requirement
Paid bereavement and jury duty leave
11 paid holidays per year
Paid time off
Paid sick leave
Flexible Spending Program
Company paid malpractice insurance for all providers
Professional development hours offered annually