REFERRAL COORDINATOR

Job Description: Referral Coordinator

Location: Care Center Classification: Full-time, Non-Exempt

Department: Medical Other Reports to: Operations Lead

Position Category: Non-Managerial Last Revised: October 2023

At ClareMedica, exceptional is the standard.

Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the ClareMedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we’re working together to help seniors live happier, healthier, fuller lives.

That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees’ growth and wellness and where their full potential and value are realized. At ClareMedica, we’re excited about great people like you. We’re even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities.

Opportunity awaits – welcome to ClareMedica.

ESSENTIAL FUNCTIONS

The primary duty of a Referral Coordinator is working with patients to arrange and schedule referral appointments. Depending on the office, this can include providing patients with referrals to other care providers, managing incoming patient referrals, or both. Referral Coordinators set appointments, send reminders, and provide patients with information about referral appointments.

DUTIES AND RESPONSIBILITIES

• Maintains a current working knowledge of all health plan carrier requirements for referral request authorizations and approval requirements.
• Provide excellent service and attention to customers when face-to-face or through phone conversations.
• Schedule initial and follow up appointments for specialist and imaging facilities.
• Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.
• Assemble information concerning patient's clinical background and referral needs.
• Per referral guidelines, provide appropriate clinical information to specialists.
• Contact review organizations and insurance companies to ensure prior approval requirements are met.
• Present necessary medical information such as history, diagnosis, and prognosis. Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians, including requesting medical records as needed.
• Review details and expectations about the referral with patients.
• Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
• Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns. May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
• Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.
• Ensure that referrals are addressed in a timely manner.
• Remind patients of scheduled appointments via mail or phone.
• Misc. administrative tasks as required by the Operations Lead.

SUPERVISORY RESPONSIBILITIES

• This position does not have supervisory responsibilities.

QUALIFICATIONS/REQUIREMENTS

• High school diploma, GED or equivalent experience required.
• Minimum 1 year experience processing referrals.
• Educated on and compliant with HIPAA regulations; maintains strict confidentiality of client information.
• Exceptional oral and written communication skills, time management skills and organizational skills.
• Ability to communicate with employees, patients and other individuals in a professional and courteous manner.
• Mindset focused on resolving problems for patients and achieving team goals.
• Knowledge of medical products, terminology, services, standards, policies and procedures.
• Ability to act calmly in busy or stressful situations.
• Demonstrated strong listening skills.
• Ability and willingness to travel locally and/or regionally up to 10% of the time to assist in covering other centers, as needed.
• Proficient skills in Microsoft Office Suite products including Word, PowerPoint, Outlook and Excel plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software. Must be able to type at least 40 WPM.
• Skilled in basic phone and computer operation.
• Ability to work effectively within role independently and with other team members.
• Ability to organize and complete work in a timely manner.
• Detail-oriented to ensure accuracy of reports and data.
• Proficiency with the ability to problem solve, multitask, and carry out instructions.
• Ability to read, write and effectively communicate in English. Bilingual is a plus.
• HIPAA and AHCA experience preferred.
• Healthcare experience preferred.
• EMR system experience preferred.

WORKING CONDITIONS

General office working conditions.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.

While performing the duties of this job, the employee will be required to stand; walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust to focus. Manual dexterity is required to use desktop computers and peripherals. Exposure to variable weather conditions is likely.

WORK ENVIRONMENT

Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

TRAVEL

Local travel between care centers may be required for coverage.

SAFETY HAZARD OF THE JOB

Minimal Hazards

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This job description does not list all the duties and responsibilities of the job. You may be asked by supervisors or managers to perform other instruction, duties, and responsibilities, as appropriate. You will be evaluated in part based upon your performance of the duties and responsibilities identified in this job description.

Management has the right to revise this job description at any time. The job description is not a contract for employment, and either you or the employer may terminate employment any time, with or without cause.