Promise Healthcare
This position is responsible for tracking and executing referrals to outside providers and obtaining authorizations for services provided.
POSITION STATUS
This position is full-time and non-exempt. The Referral Coordinator reports to the Health Information Management (HIM) Supervisor.
QUALIFICATIONS
High School Diploma
Minimum one year experience in the medical field with knowledge of medical terminology and abbreviations and understanding of patient flow processes highly preferred.
Ability to read, write and communicate clearly in English and Spanish preferred.
COMPETENCIES
Ability to appropriately communicate/deal with irritated or frustrated patients; to work under stressful conditions.
Knowledge of and ability to apply established professional customer service concepts, principles and practices.
Ability to prioritize and execute a variety of tasks simultaneously.
Ability to work with frequent interruptions.
Proficient computer skills.
Keen organizational skills.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Schedules appointments and communicates information to the patient
a. Checks Electronic Medical records (EMR) for referral order
b. Determines where to refer the patient if the Provider has not indicated a specific Provider
c. Confirms with the patient their preference for time, date, and location
d. Checks NextGen and confirms patient’s demographic information and insurance
e. Contacts Specialist and makes the appointment
f. Communicates information including directions to the site, and any information required for appointment to patient
g. Faxes or electronically sends all pertinent chart information to the Specialist
h. Researches for Specialist information as needed
2. Follows preauthorization process
a. Determines if pre-authorization is required
b. Completes appropriate request information providing any additional information required
c. Provides an explanation of the process and expected notification time to the patient
3. Approved authorization
a. Notifies patient of appointment time, date, and additional information by phone and mail
b. Contacts the specialist to schedule an appointment after obtaining preauthorization
c. Faxes or electronically sends all chart information required to the Specialist as appropriate
4. Denied pre authorizations
a. Notifies the Provider
b. Reviews the denial and provides any supporting documentation that may be required for approval
c. Notifies the patient and refers them back to their Provider for further instruction
5. Checks insurance status on all pending referrals monthly for the following month using appropriate websites
a. Notifies patient if insurance status has changed
b. Contacts Specialist to determine what is required of the patient for payment at the visit and advises patient
c. Refers patient to enrollment staff as appropriate
d. Notifies Provider if the appointment is canceled or patient did not show up for the appointment
6. Completes the Referral Process
a. Contacts the Specialist if appointment chart notes and documentation is not received
b. Forwards the referral information to HIM for scanning to patient chart and completes referral in EMR
c. Follows up with patients who do not keep specialty and imaging appointments
7. Communicates quality of care issues to Supervisor and participates in the
Plan-Do-Study-Act cycles to improve performance on targeted metrics
8. Performs clerical duties
a. Prints and distributes incoming faxes
b. May be asked to collect and distribute the mail
c. Answers and directs incoming calls to the care team
d. Checks voice mail frequently
9. a. Ensures attendance and hours worked are accurately recorded
b. Properly manages earned time off per policy
c. Responsible for regular and punctual attendance
10. Assists the care team with No show management
Job Type: Full-time
Salary: From $15.50 per hour
Benefits:
Generous earned time off (ETO) accrual
7 paid holidays annually
Health, dental, and vision insurance
Retirement plan with company match
Life insurance, short/long term disability
Flex spending account (FSA)
Dependent care account (DCA)
Employee Assistance Program (EAP)
Schedule:
8 hour shift
Day shift
Monday to Friday
Education:
High school or equivalent (Preferred)
Language:
Both English and Spanish (Preferred)
Work Location: One location
Source ⇲
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