Referral coordinator job description

CHA East Cambridge Care Center
Work Days: 8am-4:30pm
Category: Clerical and Administrative Support
Department: CHA PACE
Job Type: Full time
Work Shift: Day
Hours/Week: 40.00
Union: Yes
Union Name: SH Laborers 381
The CHA PACE plan is a Program of All Inclusive Care for the Elderly (PACE) at Cambridge Health Alliance (CHA). CHA PACE serves adults 55 years and older with chronic medical and/or mental health difficulties with the goals of achieving the highest level of community independence and preventing nursing home placement. CHA PACE's high functioning interdisciplinary team works to fully integrate and coordinate medical and behavioral health care, community resources, and in home support services.
The Referral Management Coordinator will provide on-site, pro-active management of referrals at CHA health centers. The referral manager provides excellent customer service to patients and assists in achieving appropriate care at the most convenient time. The Referral Management Coordinator will also manage the referral process at the primary care site to match CHA standards for referrals.
Job Responsibilities
1. Enter authorization numbers into referral authorization systems (to be determined).
2. Communicate assigned referral information and/or necessary decision data to providers.
3. File all documents in patient's medical record according to the established format.
4. Run daily/weekly Referral Management reports for the Referral Management Director.
5. Assist in the collection of referral utilization data.
6. Work directly with patients via the telephone to confirm and resolve issues regarding the primary care physician's referral. Add patients to CHA primary care provider panels as necessary.
7. Fax and track all referrals and certificates of medical necessity.
8. Confirm and book specialty/ambulatory appointments.
9. Assist with the implementation of all new referral management processes and programs in accordance with CHA business initiatives of providing quality customer service to all customers.
10. Develop workflow with providers to assure turnaround times standards are met. Research all referral cases that are pending and unable to be processed for payment.
11. Maintain frequent communication with Manager with respect to operational problems and/or issues that lack clear guidelines or precedents.
12. Accountable for measurement targets (to be determined).
13. Perform all job functions in compliance with all Federal, State, Local and CHA policies
Requirements:
Bachelor's degree or equivalent preferred
Work Experience: A minimum of 2 years administrative or office experience, preferably in a medical setting.
An effective team player with strong inter-personal skills.
Must have demonstrated ability to maintain dynamic and responsive interactions with patients, insurers and medical professionals.
Demonstrated ability to work and make decisions in a fast-paced environment. Proficient in Microsoft Office and other windows-based computer application programs.

In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment.

PRIMARY FUNCTION: Obtain authorization from insurance companies to assist patients in the referral process

TYPICAL WORKING CONDITIONS: Work may require sitting for long periods of time, manual dexterity sufficient to operate a keyboard, type at 40 wpm, operate a calculator, telephone, copier, and such other office equipment as necessary. It is necessary to view and type on computer screens for long periods and to work in a high-volume, fast-paced environment. Ability to work remotely is required.
ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)

1. Obtains authorizations for all referral requests received as assigned 2. Reviews and understands documentation required by insurance companies to obtain authorization, including clinical notes, lab results, consult notes 3. Utilizes insurance web portals to obtain authorizations as required 4. Accurately documents referral details, including status, authorization dates, authorization number, specialist/facility and other relevant information per policy 5. Effectively communicates updates in referral status with patients, clinicians and office site staff 6. Interacts professionally with specialists/facilities and insurance plan representatives 7. Remains current with company, health plan and specialist requirements 8. Prioritizes use of preferred specialist/facility within the EHR 9. Meets productivity standards as determined by management team 10. Manages workloads within notification and request bins in EHR to meet established timeframe expectations 11. Works collaboratively with department team members to ensure coverage 12. Manages high priority notifications and requests appropriately 13. Reviews and updates requests pending authorization daily 14. Communicates and collaborates effectively with Referral Manager and team members

Education Requirements: High School diploma or equivalent.

License: None

Knowledge, Skills & Abilities: Knowledge of medical terminology, grammar, spelling and punctuation to type correspondence. Knowledge of insurance industry. Skills in operating a computer, fax and photocopy machine. Ability to read understand and follow oral and written instruction. Ability to sort and file materials correctly by alphabetic or numeric systems. Ability to speak clearly and concisely. Ability to establish and maintain effective working relationships with patients, employees and the public. Typing ability of 40 w.p.m., word processing and computer experience.

Experience: One year experience in a medical office and/or referral coordinator experience preferred.

The Referral Coordinator is responsible for processing, follow up and communication to patients for referrals and/or procedure orders that are generated by the providers. This position will initiate the authorization for patient services. This position is responsible for knowledge of insurance coverages, documentation of authorizations, and communicates status of authorizations to the practice staff.Baptist Health Care is a not-for-profit health care system committed to improving the quality of life for people and communities in northwest Florida and south Alabama. The organization is a proud a member of the Mayo Clinic Care Network and includes three hospitals, four medical parks, Andrews Institute for Orthopaedic & Sports Medicine, and an extensive primary and specialty care provider network. With more than 4,000 team members, Baptist Health Care is one of the largest non-governmental employers in northwest Florida. Responsible for timely processing of incoming and/or outgoing referrals and orders. Documents all phone calls, messages and interactions with patients and insurance companies appropriately in the patient's chart or applicable order systems. Obtains prior authorizations for all appointments and procedures. Updates any patient demographics into the practice management system. Receives and routes incoming telephone calls in a prompt, courteous, and professional manner Operates a variety of office equipment effectively. Works closely with Baptist Medical Group Representatives, all medical facilities, insurance companies, patients and family members.Assist in other duties as assigned to support the operational needs of the department and organization. May be required to remain on campus immediately before, during, and after severe weather and/or disasters.
+ High School Diploma or General Education Degree.

+ One year of experience in healthcare or medical office is preferred.

+ Must have good communication skills verbally and written.

+ Skill in organizing work, making assignments, and achieving goals and objectives.

+ Ability to prioritize work.

+ Skill and confident with use of computers and related software applications.

+ Be able to make recommendations and handle complaints and requests in a professional and calm manner.

+ Ability to provide excellent customer service.