Referral Coordinator

GENERAL DESCRIPTION

Creates a motivating environment and promotes staff loyalty to FHCB and its mission. Exhibits and promotes a standard of excellence in the performance of all duties and interactions with patients, co-workers, and outside contacts.

The position is responsible for developing, implementing, and overseeing the patient referral process.  Employee must accurately interpret the guidelines of care as defined in each health plan and is expected to be informed regarding each plan’s requirements affecting FHCB’s referral authorization process.  The Referral Coordinator will provide customer service and facilitate appropriate authorization with various insurance vendors for simple and complex patient cases.  This position provides clerical and clinical support appropriately as a resource person and as an assistant during periods of staffing shortage. 

ESSENTIAL JOB DUTIES

1. Makes referral arrangements for all patients per clinicians' request when possible and in compliance with service network and managed care payor agreements.
2. Monitors the appropriate specialists are accessed according to managed care payor guidelines and insurance authorization is obtained as needed.
3. Assists the Practice Manager in adhering to Quality Assurance policies and procedures in accordance with stated managed care payor guidelines and provider guidelines as they relate to the referral process and patient education.
4. Monitor and track all referrals for quality assurance purposes.
5. Coordinates with payor's Member Services and Utilization Management Departments regarding authorization for pre-certified on-site/ off-site services, out-of network, and elective procedures.
6. Oversees patient compliance with specialist evaluation through monthly evaluations of referral log with follow up to lack of referral response for designated specialist groups.
7. Assist the clinical staff in managing complex patient cases through appropriate coordination of multidisciplinary care within the parameters and guidelines of office policies and the patient’s insurance plan.
8. Identifies patient access issues. Troubleshoots and assists patients experiencing difficulties obtaining specialty care appointments.

PERFORMANCE STANDARDS:

1. Must possess the ability to function independently, while maintaining a superior work ethic.
2. Must be culturally sensitive and non-judgmental. Sensitivity to patients and unique needs of special population.
3. Ability to organize and set priorities. Must be detail oriented.
4. Must possess strong interpersonal skills.
5. Proficient and timely completion of reports.
6. Ability to work in a demanding and challenging environment.
7. Must be self-motivated.
8. Adheres to HIPAA Privacy Rules as it relates to use and disclosure of Patient Health Information

EDUCATION/WORK EXPERIENCE

Minimum of one-year experience within a health care organization.  Managed Care experience.  Knowledge of medical terminology.  Degree for Medical Assistant/Medical Secretary preferred.  Must be detail-oriented, have excellent communication and interpersonal skills, ability to multi-task and take initiative. 

ENVIRONMENT/WORKING CONDITIONS

Work is performed in a clinic environment.  Involves frequent contact with staff and the public.  Work may be stressful at times.  Contact may involve dealing with angry or upset people.

PHYSICAL\MENTAL DEMANDS

Varied activities including standing, walking, reaching, bending, lifting.  Requires full range of body motion including handling and lifting patients manual and finger dexterity and eye-hand coordination.  Requires standing and walking for extensive periods of time.  Requires corrected vision and hearing to normal range.  Requires working under stressful conditions or working irregular hours.

https://fhcb.org/