Referral Coordinator

Overview

Position Summary The Referral Coordinator (RC) is a key member of the Medical department and is responsible for managing patients’ medical referrals to specialists, ancillary services, and to other NAHC departments. The RC will track all referrals in patients’ electronic health records, work closely and proactively with the clinical care pods (i.e., providers, MA’s, RN’s, Care Coordinators) to ensure patients’ referrals are effectively managed from start to finish, and that information is updated and available in the electronic health record (EHR) system.

This position requires a high level of customer service.

The Native American Health Center is an accredited institution and adheres to the standards of excellence set forth by the Accreditation Association of Ambulatory Health Care (AAAHC) and the Commission of Dental Accreditation (CODA).

Referral Coordination

• Manage and coordinate all referrals generated in the Medical department from start to finish. This will include sending referrals to specialists, ensuring their receipt, informing patients of referrals, and following up to ensure appointments were kept.
• Verify eligibility and benefits through insurance companies, including prior authorization requests.
• Coordinate and process prior authorizations for each assigned referral.
• Proactively work with Medical Assistants to ensure follow up on patients’ specialty appointments.
• Schedule specialty appointments for patients; notify and remind patients of appointments by phone and by letters through the United States Postal Service.
• Provide patient education on specialty appointments and address all patient questions to ensure understanding.
• Refer patients to NAHC’s Eligibility Specialist as needed to help ensure coverage of care related to specialists and the insurance they accept.
• Maintain a tracking system for referred appointments that includes referral date, appointment dates and times, missed appointments, and the recall procedure.
• Check referral voicemail at least once per clinic, return calls, and provide referral statuses to patients. Document patient telephone calls in an EHR Telephone Template.
• Document all telephone calls and letters in the EHR.
• Develop and cultivate positive working relationships with specialist providers.
• Document referral workflows and support Site Director in developing and editing onboarding materials for incoming staff related to referral flow and management as necessary.
• Train incoming staff on referral processes, as needed. This may include one-time trainings or ongoing trainings and onboarding.
• Proactively work with RN Clinic Manager, Lead Physician, and Site Director to resolve any technical or flow issues regarding referrals.

• Attend internal and external meetings as requested by supervisor.
• Member Care:
  Demonstrate understanding and apply working knowledge of safety policies and ensure safe member practices.
• Employee Safety:
  Safely performs all duties; follow required protective protocols to ensure personal safety and the safety of others.
• Maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.
• Quality Improvement:
  Actively participate in internal quality improvement teams and work with members proactively to drive quality improvement initiatives in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards when assigned.
• HIPAA:
  Keep all protected health information (PHI) confidential and abide by HIPAA policies for the release and disclosure of any PHI. Will report unauthorized use of disclosure of PHI immediately to supervisor or HIPAA security officer.
• Work well under pressure, meet multiple and often competing deadlines.
• At all times demonstrate cooperative behavior with supervisors, subordinates, colleagues, clients and the community.
• Other duties as assigned by Supervisor.