Referral Coordinator

Summary

The Referral Coordinator is responsible for the effective management of all incoming specialist referrals.

Duties and Responsibilities

• Responsible for coordinating and processing of all patient referrals for specialty services.
• Utilizes a high degree of accuracy in obtaining and verifying that all registration data, demographic and insurance information is correct and up to date.
• Acts as liaison between Community Medical Group and other healthcare providers while exhibiting and utilizing a high level of customer services skills.
• Performs eligibility checks on members as necessary by telephone or electronically as appropriate.
• Follows procedures for proper authorization and processing of all referral services including obtaining approval from our medical director.
• Supports physicians and patients in synchronizing appointments, authorizations and tests taking place in different clinics.
• Sets up appointments and transportation as necessary.
• Contacts the patient on a timely basis for all scheduling requirements.
• Communicates with patients to ensure follow-through with referrals.
• Ensures strict confidentiality of all health records, member information and follows HIPAA guidelines.
• Coordinates pre-admission testing requirements with clinic personnel and patients.
• Completes all administrative functions related with referral activities in an efficient manner.
• Enters all referral, hospital, outpatient and other patient specialty health service authorizations into the computer system following CMG policies and procedures.
• Responsible for monitoring all referral reports not received and follow-up in a timely manner.
• Performs duties in honest and ethical manner.
• Perform other duties as assigned.

Qualifications

• Education/Experience:
• Must have High school diploma or equivalent.
• Prior experience in a clinical setting
• MS Office programs experience.
• Medical Assistant training or certification preferred.
• Knowledge of medical terminology and CPT, HCPCS and ICD coding preferred.
• Knowledge of Electronic Health Records (EHR) preferred

Skills:

• Use relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
• Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines and standard accepted practices
• Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Ability to work with individuals within and outside the organization, in professional and courteous manner.
• Must develop constructive and cooperative working relationships with others.
• Understand written sentences and paragraphs in work related documents.
• Strong ability to use independent judgment and initiative.
• Organized and able to manage competing priorities.
• Resourcefulness in problem solving.
• Actively look for ways to help people.
• Strong written and verbal communications skills
• Knowledge of medical terminology
• Must be extremely detail oriented.
• Strong organizational and interpersonal skills.
• Knowledge of EHR
• Bilingual skills preferred (English/Spanish or English/Creole)
• Must develop constructive and cooperative working relationships with others.