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The Referral Coordinator is responsible for coordinating, distributing, and following-up on referrals originating from our dental, medical, and behavioral health departments. They must use their interpersonal skills to resolve scheduling and access related issues as well as effectively collaborate with patients, team members, physicians, and other stakeholders to maintain a high level of efficiency and quality of care. Must have strong communication skills, providing patients with appointments, and information about their appointments. Must have strong organizational skills to provide operational support to assigned department and uphold the mission, vision, and values of SDAIHC. 

Essential Duties and Responsibilities:

 

Primary Functions:

 

1. Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake and notification roles.
2. Work with hospitals, clinics, facilities, and the clinical team to manage requests for services from members and/or providers and provide information on available network services.
3. Verifies eligibility and benefits for each referral and accurately documents into EHR.  

1. Processes electronic referrals in queues and generates authorizations.
2. Accurately uses EHR for daily documentation of information required for denial letters for patients whose benefits do not cover requested services.
3. Interfaces effectively with physicians and medical staff to provide referral process training as needed.
4. Provide appropriate triage and care coordination notification cases for non-clinical assessment/intervention.
5. Handle resolution/inquiries from members and/or providers.
6. Other duties as assigned.

 

 

Qualifications:

Minimum Qualifications:

 

1. High School diploma or GED.
2. Minimum 1 to 2 years of experience.
3. Experience working within the health care industry and with health care insurance.
4. Knowledge of and experience with medical terminology and procedural coding required; includes ability to interpret insurance information.
5. Clerical or administrative support background.

1. Knowledge of ICD-9 and CPT codes.

1. Experience with insurance plans, including Medicare and/or Medicaid, third-party payer practices and guidelines, and pre-certification and referral management for insurance plans.

Preferred:

1. Medical assisting, or other clinical degree.

1. Experience serving a multinational, multicultural population.
2. FQHC experience.

 

 

Special Conditions of Employment:

 

1. CPR Certification in good standing
2. COVID-19 Fully Vaccinated 
3. Clean driving record and insurance as required by the state.

1. Reliable transportation.

 

knowledge, Skills, and Abilities:

1. Excellent oral and written communication skills.
2. Excellent time management skills
3. Excellent organizational skills and attention to detail.
4. Ability to maintain confidentiality and meticulous records.
5. Effective interpersonal skills.
6. Able to deal effectively with a diversity of individuals.
7. Ability to establish and maintain cooperative working relationships with all during the course of work.
8. Bilingual in Spanish/English a plus
9. Must be reliable and extremely trustworthy. 
10. Demonstrated proficiency in Microsoft Suite or related programs. Ability to learn other accounting software systems.

 

 

 

Physical and Mental Requirements:

1. Able to lift/move up to 10 pounds, move from place to place.
2. Able to sit at a desk and work on a computer for prolonged periods.
3. Able to stand, bend and reach for prolonged periods.
4. Ability to do math, organize and prioritize workload, work effectively and efficiently under stress.
5. Ability to supervise, multitask, understand, and follow instructions.
6. Ability to proficiently read, write, speak, and understand English

 

 

Customer Service:

 

1. Actively supports, promotes, and works to fulfill the Mission, Vision, and core values of SDAIHC.
2. Provides excellent internal and external customer service.
3. Demonstrates SDAIHC’s Standards of Customer Service Behavior: Compassion, Attitude, Communication, Appearance, Sense of Ownership, and Teamwork.
4. Participates in on-going customer service training.
5. In every action, seeks to promote SDAIHC as a top service organization.

 

 

Quality Management:

 

1. Contribute to the success of the organization by participating in quality improvement activities.
2. Complies with all SDAIHC policies and procedures and proactively participates in the implementation of new initiatives.
3. Participate and ensures continuous quality improvement process as directed by clinic leadership.  

 

 

Safety:

 

1. Ensures regulatory compliance and adherence with policies and procedures related to safe work practices.
2. Participate in infection prevention through appropriate use of infection control measures during patient treatment and patient interactions.
3. Ensure compliance with regulatory requirements for maintaining physical spaces, equipment, and supplies.  
4. Uses all appropriate equipment and/or tools to ensure workplace safety. 
5. Immediately reports unsafe working conditions. 

Privacy/Compliance:

           

1. Maintains privacy and security of all patients, employee, and volunteer information and access to such information. Such information is accessed on a need-to-know basis for business purposes only. 
2. Complies with all regulations regarding corporate integrity and security obligations. Reports on unethical, fraudulent, or unlawful behavior or activity.
3. Upholds strict ethical standards.

 

   Flexibility:

1. Available for all shifts and, when required, able to work evenings and weekends.

           

 Disclaimer

 

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This description reflects management’s assignment of essential functions; it does not proscribe or restrict the tasks that may be assigned. This job description is subject to change at any time.

 

Preference is given to qualified American Indian/Alaskan Natives in accordance with the American Indian Preference Act (Title 25, U.S. Code Section 472, 473 and 473a). In other than the above, the San Diego American Indian Health Center, is an equal opportunity employer.

  

 

San Diego American Indian Health Center is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, gender identity, gender expression, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation, or belief.