Referral Coordinator

We're unique. You should be, too.

We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We're different than most primary care providers. We're rapidly expanding and we need great people to join our team.

The Care Coordinator 2 is a highly visible customer service and patient-focused role. The incumbent in this role works directly with our patient population and their families, insurance representatives and outside vendors, physicians, clinicians and other medical personnel to ensure the referral process runs smoothly. He/She operates in a dynamic and professional environment to ensure the highest level of quality healthcare is delivered to our members.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

* Coordinates patient referrals with specialists and/or hospitals, completes referral requests and transmits medical records and correspondence via mail and/or secured fax or email.

* Trains new Care Coordinators and assists with training on new processes with direction from Referral Manager.

* Manages approval flows and follows up with approvers who do not respond within a 24 hours period.

* Communicates responses to Referral team.

* Provides coverage for Care Coordinators when calls-ins, PTO or unavailable and/or in times of high patient volume.

* Serves as a backup to the Referral Manager when unavailable.

* Assists Care Coordinators on complicated referrals.

* Assists with orders, as needed, per Referral Manager. Coordinates surgical procedures with Tier 1, 2 & 3 providers. Assists Skilled Nursing Facility (SNF) team with follow-up on orders.

* Coordinates and processes patient referrals to completion with precision, detail and accuracy.

Definition of completion:

* Prioritizes HPP patients in Primary Care Physicians panel, stats, expedites and orders over 5 days.

* Orders have been approved (when needed).

* Schedules patient (Preferred Providers List of Specialist) and notifies them of appointment information, including, date, time, location, etc.

* Uses Web IVR to generate authorizations (Availity, Careplus, Healthhelp NIA and any other approved web IVR for authorization processing).

* Completes orders with proper documentation on where patient is scheduled and how patient was notified.

* Referrals have been sent to specialist office & confirmed receipt.

* Provides extraordinary customer service to all internal and external customers, including, but not limited to: patients colleagues, physicians, etc. at all times. Establishes and maintains relationships with service providers and clinicians.

* Ensures assigned tasks are completed precisely and accurately.

* Ensures Preferred Provider List is used accurately and effectively. Collaborates with referral management to ensure specialist network is adequate for the geography and escalates accordingly when network adequacy impacts access to care.

* Performs other related duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

* Knowledge of medical terminology, CPT, HCPCS and ICD coding preferred

* An inept understanding of the company's patient population, including the complexities of Medicare programs to patients in the current healthcare marketplace

* Detail-oriented with the ability to multi-task. Must be open to cross-functionally training in referrals and back office duties

* Able to exercise proper phone etiquette with the ability to navigate proficiently through computer software systems

* Team-oriented with the ability to work extremely well with patients, colleagues, physicians and other personnel in a professional and courteous manner

* Exceptional organizational skills with the ability to effectively prioritize and timely complete tasks

* Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, database, and presentation software

* Ability and willingness to travel locally within the market up to 10% of the time

* Spoken and written fluency in English;
Bilingual a plus

PAY RANGE:

$20.2 - $28.83 Hourly

The posted pay range represents the base hourly rate or base annual full-time…