Referrals - Referral Coordinator
About The Position
At Unicare, we strive to provide high quality health care to the community we serve. Our goal is to provide easily accessible, comprehensive, and affordable health care to every family member, while reducing visits to emergency rooms and urgent care facilities. Our mission is to be a community health care organization that treats everyone with dignity and, respect and cultural sensitivity to help create an environment in which all can prosper. Job Summary 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.
Requirements
- High school diploma or GED required.
- One (1) to two (2) years referral experience.
- Bilingual in English/Spanish required.
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. 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.
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What This Job Offers
Career Level
Entry Level
Education Level
High school or GED
