Referral Coordinator

Presbyterian System Services • Rio Rancho, NM

5d • Onsite

About The Position

Presbyterian is hiring a skilled Referral Coordinator. This full-time position is based at Presbyterian Rust Medical Center and involves a weekday schedule, Monday-Friday. The Referral Coordinator will navigate complex requests from referring providers and their offices, primarily via phone, developing and maintaining positive working relationships. They will address requests and concerns using knowledge of the organization and identifying resources, employing a high level of diplomatic skill to handle all calls professionally. Advanced scheduling for specialty or radiologic procedures, recognizing payor requirements, and obtaining prior authorization/certification/referrals for visits/procedures are key aspects of this role. The coordinator will also scrub schedules for accuracy and efficiency, monitor in-baskets and reports for overdue results, waitlisted appointments, and recalls, and ensure an exceptional experience for providers and referring offices using CARES, AIDET, and EPE tools. Effective communication with providers and patients in a timely manner is essential.

Requirements

• High school or equivalent
• Minimum 18 months experience in a medical office setting with significant MD interaction
• Proficiency in prior authorization/certification/referral process
• Must pass EPIC competency for Registration at completion of Epic Clerical Training class
• Short-term training in Medical Terminology
• Working knowledge of CPT and ICD-10 coding
• Pass annual competency exam for all areas of responsibility
• Requires strong organizational and multi-tasking skill sets
• Significant customer service skill set
• Must be able to function under pressure while maintaining professionalism

Responsibilities

• Navigate complex requests from referring providers and their offices, primarily via phone.
• Develop and maintain positive working relationships with providers and referring offices.
• Address requests and concerns using knowledge of organization and ability to identify resources.
• Use high level of diplomatic skill to handle all calls in positive and professional manner.
• Advanced scheduling for specialty or radiologic procedures.
• Recognize payor requirements and obtaining prior authorization/certification/referrals for visits/procedures.
• Return scheduling knowledge to include the ability to scrub schedules for accuracy and efficiency in home department.
• Monitor in-baskets and reports for overdue results, waitlisted appointments, recalls, etc.
• Achieve exceptional experience for providers and referring providers offices by using CARES, AIDET and EPE tools.
• Ensures all communications with providers and patients occurs in a timely manner.
• Communicates with referring providers and their offices to schedule referrals, answer questions, and arrange provider-to-provider communication as needed.
• Addresses and attempts to appropriately resolve concerns and requests in the moment by using resources and appropriate escalations to find solutions.
• Coordinates with departments throughout program to gain access for referrals.
• Follows up with referring providers to ensure they know the status of their referral or request.
• Maintains strong knowledge of program operations and processes in order to guide referring providers and answer questions about potential referrals and perform appropriate hand-offs.
• Coordinates with Business Development partner to collect feedback from referring offices in order to ensure an exceptional experience.
• Ability to manage conflict and appropriately request the help of a supervisor when needed.
• Fosters effective patient relations with patients, the public and providers by listening, responding and escalating when appropriate.
• Works with program providers, testing departments, and health plan representatives to facilitate creating access for referrals and members as needed.
• Facilitates provider-to-provider communication as requested.
• Coordinates incoming referrals from the time they are received to completed.
• Enters all faxed referrals into EHR.
• Guides and assists referring offices through Prior Authorization request requirements and processes.
• Understands surgical and procedural scheduling workflows in order to appropriately prepare and hand-off referrals.
• Ensures relevant medical records are requested.
• Ensures any testing required for referral is ordered and scheduled.
• Communicates effectively to ordering clinician when any restriction, such as access, restricts or prohibits scheduling as ordered.
• Supports program providers with scheduling, access coordination, and referral communication needs.
• Refers as appropriate to on site Financial Advocate, or for uninsured to the Financial Advocacy Center.
• Validate prior authorization/certification/referral are secured PRIOR to a scheduled procedure or test, alerting stake holders (patient, patient representative, OR, etc) if a breakdown occurs.
• Answers all incoming provider calls; including from outpatient referring offices, inpatient requests for consults, and internal program providers.
• Follows established workflows for paging the appropriate program providers regarding consult requests.
• Formulates complete and accurate telephone encounter messages and routes to the appropriate Epic in-basket pool to support operational aspects of patient care.

Benefits

• Medical
• Dental
• Vision
• Short-term and long-term disability
• Group term life insurance
• Other optional voluntary benefits
• Employee Wellness rewards program (earn gift cards and more by participating in wellness activities like wellness challenges, webinars, preventive screenings, and more)

What This Job Offers

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