Referral Coordinator - PRMC

Presbyterian Healthcare Services • Elk City, OK

4d • $17 - $28 • Onsite

About The Position

The Referral Coordinator will navigate complex requests from referring providers and their offices, primarily via phone. This role involves developing and maintaining positive working relationships with providers and referring offices, addressing requests and concerns using organizational knowledge and resource identification, and employing a high level of diplomatic skill to handle all calls in a positive and professional manner. Responsibilities include advanced scheduling for specialty or radiologic procedures, recognizing payor requirements and obtaining prior authorization/certification/referrals for visits/procedures, returning scheduling knowledge to include scrubbing schedules for accuracy and efficiency in the home department, and monitoring in-baskets and reports for overdue results, waitlisted appointments, recalls, etc.

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

• 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.
• Validates prior authorization/certification/referral are secured PRIOR to a scheduled procedure or test, alerting stakeholders (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.
• Instructs patients on the Release of Information process and ensures a fully completed ROI Form is submitted to Health Information Management for incoming or outgoing records.
• Comprehends quality service connection to patient satisfaction and reimbursement.
• Participates in metric goals for telephones performance metrics, TSF and abandonment rate when applicable.
• Performs confirmation calls when applicable to include directions and instructions as required by the visit type.
• Responds quickly to patients showing distress.
• Follows guidelines set forth by the Clinic Manager to alert the clinical team.
• Assists in any manner the clinic team directs.
• Ensures check-out area, waiting area and walkways are clear of any unnecessary items and are clean and neat.
• Reports any concern that may create a safety issue.
• Completes annual competency for Clerical Staff during a Code Blue.
• Performs appointment reminder calls.
• Reschedules appointments.
• Evaluates provider schedules and takes appropriate action to ensure accuracy and efficiency per guidelines.
• Works with assigned physicians to maximize schedule effectiveness.
• Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Short-term disability
• Long-term disability
• Group term life insurance
• Optional voluntary benefits
• Wellness rewards program (gift cards, wellness challenges, webinars, preventive screenings)

What This Job Offers

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