Referrals - Referral Coordinator

Unicare Community Health Center•San Bernardino, CA

About The Position

Referral Coordinator I is responsible for coordinating the care between the medical providers and the specialists to ensure that the patients are getting the appropriate care. Duties/Responsibilities: Responsible for processing the referrals submitted by health care providers in all referral queues.Must complete the referral life cycle, submit-approve-notify patient-follow-up-secure medical records within the identified time periods.Adhere to insurance requirements and closely communicate with clinicians for all clinical care needs to process a referral.Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. This tracking may use an EHR database.Ensure complete and accurate registration, including patient demographic and current insurance information.Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, and prognosis. Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians.Review details and expectations about the referral with patients.Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising 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.Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers. Ensure that referrals are addressed in a timely manner.Remind patients of scheduled appointments via mail or phone.Ensure that patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.Any and all other duties as assigned. Non-Essential Functions As directed by the Referral Supervisor, performs other related and/or necessary tasks to achieve organizational and programmatic goals and objectives. Professional Requirements Adhere to dress code, appearance is neat and clean. Maintain patient confidentiality at all times. Report to work on time and as scheduled. Maintain regulatory requirements, including all state, federal and local regulations. Represent the organization in a positive and professional manner at all times. Comply with all organizational policies and standards regarding ethical business practices. Communicate the mission, ethics and goals of the organization. Participate in performance improvement and continuous quality improvement activities. Must have reliable transportation.

Requirements

High school diploma or GED required.
One (1) to two (2) years referral experience.
Bilingual in English/Spanish required.
Adhere to dress code, appearance is neat and clean.
Maintain patient confidentiality at all times.
Report to work on time and as scheduled.
Maintain regulatory requirements, including all state, federal and local regulations.
Represent the organization in a positive and professional manner at all times.
Comply with all organizational policies and standards regarding ethical business practices.
Communicate the mission, ethics and goals of the organization.
Participate in performance improvement and continuous quality improvement activities.
Must have reliable transportation.
Excellent people skills, with an ability to partner with a dynamic leadership team.
Possess personal qualities of integrity, credibility, and commitment to corporate mission.
Flexible and able to multitask; can work within an ambiguous, fast-moving environment, while also driving toward clarity and solutions; demonstrated resourcefulness in setting priorities.
Strong customer service focus
Effective verbal and written communication skills
Teamwork orientation
Organized and able to manage competing priorities
Good judgment
Resourcefulness in problem solving
Able to take and follow through with delegated tasks and accountability

Nice To Haves

Medical assistant certification preferred.

Responsibilities

Responsible for processing the referrals submitted by health care providers in all referral queues.
Must complete the referral life cycle, submit-approve-notify patient-follow-up-secure medical records within the identified time periods.
Adhere to insurance requirements and closely communicate with clinicians for all clinical care needs to process a referral.
Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.
Ensure complete and accurate registration, including patient demographic and current insurance information.
Assemble information concerning patient's clinical background and referral needs.
Per referral guidelines, provide appropriate clinical information to specialist.
Contact review organizations and insurance companies to ensure prior approval requirements are met.
Present necessary medical information such as history, diagnosis, and prognosis.
Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians.
Review details and expectations about the referral with patients.
Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising 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.
Identify and utilize cultural and community resources.
Establish and maintain relationships with identified service providers.
Ensure that referrals are addressed in a timely manner.
Remind patients of scheduled appointments via mail or phone.
Ensure that patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.
Any and all other duties as assigned.
As directed by the Referral Supervisor, performs other related and/or necessary tasks to achieve organizational and programmatic goals and objectives.