Job Description

JOB TITLE: Referral Coordinator

DEPARTMENT: Case Management

REPORTS TO: Case Management Supervisor

The referral case coordinator’s obligations of duties can be found summarized below.

Responsibilities

DUTIES/RESPONSIBILITIES:

1. Responsible to monitor and oversee the patient referral system.

2. Shall process and monitor all patient referrals and managed care authorization requests.

3. Shall ensure that all initiated referrals or authorizations received are accurately and thoroughly completed as required prior to submission (in efforts to avoid delays).

4. Insures that all referrals authorization requests are scanned within a timely manner (urgent, routine, etc.).

5. Ensures that referrals and authorization requests are filed appropriately and maintained in the patient’s electronic health record.

6. Shall maintain a record of all referrals process in |2| software. Record shall include: patients name, Chart #, date referral was faxed or mailed, date of appointment, if patient kept the appointment, authorization # (if applicable).

7. Will maintain a list of referral sources and contacts.

8. Shall ensure to request Release of Records (R.O.R. from Specialists) for all appointments or referrals made and will make every effort to ensure the receipt of the R.O.R.’s.

9. Will forward R.O.R.’s to the applicable provider for review and approval prior to filing the documents in the patient E.H.R.

10. Responsible to keep department records in an organized and orderly fashion (files, binders, etc.).

11. Will inform supervisor regarding any grievances related to an IPA, HMO, hospital, or other facilities.

12. Shall follow-up on all patients referred to the Emergency Room (ER) by an FHCCGLA provider or who had a recent E.R. visit.

13. All other duties assigned.

Qualifications

MINIMUM QUALIFICATIONS:

1. High school diploma, minimum (or GED equivalent).

2. Medical Assistant Certificate (Preferred).

3. Requires exceptional organizational skills.

4. Computer literate.

5. Spanish speaking required.

6. Strong communication, interpersonal skills, and problem solving skills.

7. Ability to take initiative in performing and completing tasks.

8. Ability to prioritize workload and work under pressure of deadlines.

9. Willingness to adapt to changes in clinic schedules, agency growth and expansion.

ADDITIONAL ELIGIBILITY QUALIFICATIONS

1. Ability to work well with others in a professional and team-oriented environment.

2. Well-developed interpersonal skills, friendly personality and able to motivate staff by promoting teamwork.

3. Ability to relate to the public regardless of ethnic, religion and economic status.

4. Excellent communication skills.

5. Willingness to travel.

6. Strong planning and organizational skills.

7. Problem analysis and critical thinking skills.

8. Excellent customer service skills.

9. Knowledge of the following (but not limited to), preferred:

My Health LA PPO’s HMO’s

Medicare Family PACT CPSP

Medi-Cal Fee-for-Service CHDP

Managed Care Plans Every Woman Counts