Job Description

Essential Functions

1. Coordinates patient care by reviewing, submitting, and tracking referral requests daily within assigned insurance, health program, or IPA referral tracking and/or EMR systems to ensure timely access to needed services.
2. Gathers and compiles medical records related to referral requirements to support approval.
3. Per insurance or IPA referral guidelines provide appropriate clinical information to specialists.
4. Coordinates with care coordinator and medical records staff to track the status of all provider reports for patients referred to hospitals, outside clinics, and specialty providers, and follows up on any reports or records not received for referred patients.
5. Takes initiative and coordinates along with care team and provider when issues arise in the referral process.
6. Contacts insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis, and prognosis and provides specific medical information.
7. Fax approved referral authorizations when received.
8. Denied referrals must be followed up to ensure all required documents are sent to receive approval.
9. Coordinates and schedules referral appointments with outside specialists as needed, resolving issues and communicating effectively to ensure timely and appropriate patient care.
10. Documents accurately external referral patients’ appointments that are kept, failed, and current status in the referral tracking system and/or EMR.
11. Tracks and follows-up on referrals (i.e. STAT, Urgent, Emergent, Routine and Pending); supported by a minimum of 3 documented efforts in EMR to notify patients when approved referral is received.
12. Assists in the submission and tracking of referral entries for outstanding providers that are 30 days or more old, and follow-up with the appropriate provider when necessary.
13. Ensures all referral forms are sent to medical records on a timely manner, after referral process has been completed.
14. Be able to process an average of 35+ referrals on a daily basis.
15. Provides essential support during high-demand or short-staff situations by answering patient phone calls, requests, and questions promptly, documenting accurately in the EMR, and ensuring calls are properly managed or redirected to maintain continuity of care.
16. Respond to in-house provider questions, requests, and concerns regarding the status of patient referrals, care coordination, or follow-up status.
17. Verify insurance information for referral processing purposes when necessary.
18. Stays current with updates and changes in insurance and IPA referral guidelines.
19. Attends staff meetings and assigned trainings.
20. Other duties as assigned.

Required Education and Experience

1. High school graduate, GED, or equivalent required
2. Certified Medical Assistant, AA Degree preferred
3. Microsoft Office (Word, Excel, Outlook)
4. Previous Customer Service experience
5. One year Referral experience in a FQHC setting

MEDICAL-RELATED SUPPORT

In addition to the above-listed core job functions, these positions involve significant emphasis on all aspects of medical-related document preparation, including; transcribing dictation, summaries, reports and other medical-related correspondence and documentation.

Skills

• Good understanding of medical terminology.
• Basic Computer Skills (Microsoft Office, Internet Applications).
• Clear and effective communication skills.
• Able to display adaptability, empathy, patience, and has a positive attitude.
• Fast learner with great attention to detail.
• Fosters and promotes a culture of service excellence and accountability.
• Consistently adheres to a high standard of professional ethics; conducts self in an ethical manner and is a role model to others.
• Promotes and believes in the mission statement: “Helping People Heal.”
• Believe and aligns with the core values: Compassion, Respect, Integrity, Accountability, and Teamwork.
• Treats everyone equally regardless of racial, ethnic, religious, social, and economic status or background.
• Performs all job functions in a professional and courteous manner.
• Performs job duties collaboratively and maintains proactive communication with referral team and exercises good judgement.