Referral Coordinator (40 hours/week)

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Summary

Job Description

POSITION SUMMARY: The Referral Coordinator is responsible for coordinating specialty care and testing for patients in need of external consultations and diagnostic imaging as requested by the Primary Care Physician. This includes but is not limited to obtaining authorizations from insurance and  scheduling with External Providers. Ensures compliance with hospital policies, billing guidelines, and payer policies. 

HOURS: Monday-Friday between the hours of 7:30am-5:00pm

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

• Serves as first-line resource for all customers (internal/external) with regards to referrals. Must have a basic understanding of the referral process.
• Completes 2 of the following Job Functions:

  Obtain insurance referrals & authorizations for diagnostic testing and procedures; communicate with referrring physicians for peer to peer and denials follow up. Will be required to maintain a working knowledge of Insurance verification and authorization.

  Process patient referrals to specialty providers by preparing medical records and providing appropriate clinical information to the specialist. Communicating appointment information and expectations with patients in a timely manner. Complete outreach to obtain consult notes for completed appointments.

  Working knowledge of diagnostic imaging scheduling, cancelling and rescheduling process in EPIC. Completes outreach to patients and schedules imaging appointments in EPIC; reviews details and expecatations with the patients for their upcoming appointments. Provide follow up phone calls once consult appointments have been scheduled to notify patients of appointments; as well as outreach to obtain consult notes for completed appointments

• Maintain appropriate and accurate documentation.
• Adheres to team standards and work flows
• Attempts to understand patients needs and offers guidance and resolution of issues through collaboration with team members and outside departments.
• Demonstrates excellent “over the phone” patient relations skills, e.g. smiles, cheerfully greets patients, and engages all patients in a  genuine, warm, and caring manner.
• Maintains regular consistent attendance, personal appearance, punctuality, and adherence to applicable health and safety procedures.

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

• Identifies work processes that can be improved upon, eliminated, or handled through electronic processes and escalates to leadership.

• Basic knowledge of Family Medicine Practices, purpose and operations.
• Basic medical terminology.
• Knowledge of various insurance plans such as Medicaid, Medicare and Commercial insurances.
• Ability to work efficiently and comfortably with all levels of staff.
• Performs other related duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

• High school diploma or certificate
• One (1) year experience in a healthcare setting
• One (1) year experience in customer service related field

PREFERRED QUALIFICATIONS:

• One (1) year of using medical terminology
• One (1) year experience in medical referral/insurance

COGNITIVE REQUIREMENTS

Attention/Concentration: The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others.

• The position requires the ability to attend to more than one aspect of a situation simultaneously.  It is highly likely that multiple task demands are going to be required of the individual at the same time.

New Learning and Memory: The following level of ability is essential for the jobholder to learn and retain material.

• The position requires that an individual be able to learn new tasks quickly and effectively.  Job requirements change frequently.  The ability to understand and carry out detailed, involved instructions is mandatory.
• A large portion of this position required reliance on verbal memory and new learning.  Efficiency in processing of verbal information, either in written or spoken form, is a major requirement and prerequisite of the job.  The individual must be able to attend to and process multiple bits of information simultaneously.  The individual must be able to organize and categorize this information effectively so that later recall is feasible.

Problem Solving, Reasoning and Creative Thinking: The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought.

• The position deals with issues or problems that often require thoughtful reasoning before arriving at approaches or solutions.  Some independent thought, planning or origination of options and solutions is necessary.  The individual must have the ability to apply principles of reasoning and problem solving to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

APTITUDES:  The following are essential requirements of the position in relation to job-worker situations.  These items describe how a worker must adapt, adjust, conform or act.

Communication:  Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.

Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.

EQUIPMENT USAGE REQUIREMENTS

Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies

Software: Microsoft Office Products, EPIC, RightFax, various web-based insurance portals.

PHYSICAL REQUIREMENTS

Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%

Body Position/Movement:

• Sit: Continuously 71-100%
• Stand: Rarely 0-10%
• Walk: Rarely 0-10%
• Bend: Rarely 0-10%
• Push: Rarely 0-10%
• Pull: Rarely 0-10%
• Kneel/Squat: Rarely 0-10%
• Reach: Rarely 0-10%
• Twist: Rarely 0-10%
• Balance: Rarely 0-10%
• Climb: Rarely 0-10%

Lifting: Degree of physical exertion is:

Light, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.

Sensory Abilities specifically required:

• Vision
• Hearing

PHYSICAL ENVIRONMENT

WORKING CONDITIONS: Exposure to hazardous conditions/ materials is negligible.

                                  

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job.  It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards.  The percentages of time spent performing job duties are estimates, and should not be considered absolute.  The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole.  Incumbent must be able to perform all job functions safely.

Disclaimer

MILL Full Time Posted on 10/10/2024