Title: Referral Coordinator

Supervisor: Care Coordination Manager

Department: Clinic-Commons

Exempt Status Non-exempt

Essential Functions

The Referral Coordinator in coordination with the Care Coordination Manager and provider team provides advocacy, referral, and follow-up to patients in conjunction with the medical plan of care. Completes up to (20) twenty referrals a day. Responds to all calls/or makes calls per day. Supports all physicians each day.

Seeks guidance from RN and Providers as needed for clinical resources:

This position provides extensive support to providers and patients. Maintains relationships with specialists, with outside partners in health care, i.e. schools, county programs, other providers, hospitals to coordinate services and support the community.

Responsibilities:

Under general supervision, the Referral Coordinator’s primary responsibilities include but are not limited to:

• Independently reviews patient medical records by reading provider notes to ascertain what care intervention is needed.
• Follows up on pending lab reports, x-rays, appointments, or other planned evaluation and treatment as needed to coordinate referrals.
• Coordinates and schedules all types of diagnostic or screening testing as requested by specialist or PCP.
• Reviews and explains exam preparations to patients. Asks questions and ensure explanation is understood.
• Tracks and follows up on status of all pending hospital authorizations, appointments, applications, insurance eligibility and referrals.
• Process referrals and follow-up, schedules appointments with specialists within a timely manner. Informs provider if there is an unusual delay.
• Utilizes MS Outlook software to set reminders and course of follow up referrals. No incidences of missed referrals.
• Maintains complete, current, and accurate chart notes which includes date, action taken, contact information of referral, current patient demographics and insurance eligibility in conjunction with medical plan of care.
• Attend regularly and as scheduled Referral Coordinator and All Staff meetings as scheduled by Care Coordination Manager.
• Handles patient complaints in professional manner and refers patients as necessary to appropriate clinic management if patient’s complaint is too complex for Referral Coordinator to handle.
• Responds to patient or staff inquiries and request within a 24 hour period.
• Responds to patient, staff or outside service calls within a 3 hour period.
• Request prior authorizations from: Medicare, Medicaid, BCBS, Cigna, UHC, etc…insurance companies for medications, specialist office visits/follow-up’s, medical equipment and procedures.
• Assist patient’s in-person by making appointments or explaining process of referrals, services or resources. Displays excellent customer service when doing so.
• Faxes pertinent medical records, demographic information, and insurance eligibility to different specialist offices.
• Maintains relationships with outside services by working in a professional manner, following specialists’ protocols, and provides patient information in a timely manner and displaying a customer service and professional attitude.
• Care Team responsibilities.

In-House Specialists:

• Manages schedules for In-House specialists.
• Maintains waiting lists and appointment scheduling of In-House specialty clinics, or notifies person in charge of specialty care of patients who need appointment. Calls or e-mails in-House specialist or assistant four weeks in advance to confirm next available dates and one week in advance to remind of next scheduled date.
• Confirms in-house specialist appointments with patient 2 weeks prior to the appointment. Mails letter if necessary.
• Handles all case management follow-up issues/requests after the patient has been seen by the specialist.
• Maintains and coordinates other assigned specialty referrals, as assigned.

Qualifications:

Ability to read and interpret medical records in English

Excellent written and verbal communication skills.

Ability to chart actions clearly.

Ability to work with patients and representatives of other organizations on the phone.

Must be Bi-lingual English-Spanish or English

Must be sensitive to multi-cultural, multi-ethnic issues.

Knowledge of medical terminology preferred.

Must be able to work in centralized department setting

Must be able to work in team environment setting.

Must display excellent customer service ability

Must have attention to detail abilities

Must be reliable

Must be able to work in team environment setting .

Must be able to perform the essential functions of the job.

• Participate in continuing education programs and competency training. Ensure that all policies and procedures related to process, service, and employee work rules are followed. Maintain confidentiality in all matters related to patient care and visitor issues on non-English speaking patients/families/escorts.
• Maintain his/her own clinical and mandatory education requirements and for meeting the established standards of their profession.
• Provide care in a non-judgmental, non-discriminatory manner that is sensitive to patient/family diversity while preserving each patient’s autonomy, dignity and rights.
• Conduct self in a professional manner at all times – this includes arriving to work on time and completing each shift as determined by SUHWC.
• Maintains positive behaviors, approaches, attitude, and commitment to interpersonal service toward patients, visitors, and co-workers.
• Perform other related duties incidental to the work described herein.

Non-Essential Job Functions

• Attend and participates in staff meetings and in-services as assigned.
• Adhere to and support SUHWC’s policies, practices and procedures.
• Accept assigned duties in a cooperative manner and perform all other related duties as assigned by Supervisor.
• Work scheduled shifts.

Knowledge, Skills and Abilities

• Must be able to demonstrate a working knowledge of computers, fax, phone and other office machines.
• Must have excellent communication skills, be able to cope with mental and emotional stress related to the position, function independently, and have flexibility and personal integrity.
• Must demonstrate on an ongoing basis the ability to develop and maintain good working relationships with co-workers.
• Bilingual preferred (Spanish)

Working Conditions/Physical Demands

Requires frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling. Ability to communicate verbally, and in writing with an excellent comprehension of the English language. Work is generally performed in an indoor, well-lighted, well-ventilated, heated and air-conditioned environment.

Education /Certification /Licensure

High school diploma/equivalent required.

College degree preferred, post graduate degree a plus.

Medical assistant or other support staff role experience in a medical facility setting with at least 2 year’s experience preferred.

UHC Referral Coordinator

United Health Centers is an Equal Opportunity Employer

Job Type: Full-time

Pay: $13.00 per hour

Benefits:

• Dental Insurance
• Disability Insurance
• Health Insurance
• Life Insurance
• Paid Time Off
• Retirement Plan

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Healthcare: 1 year (Required)

Location:

• Winston-Salem, NC 27104 (Required)

Language:

• Bilingual (Required)

Work Location:

• One location

Company's website:

• www.uhcenters.org

Benefit Conditions:

• Waiting period may apply
• Only full-time employees eligible

Work Remotely:

• No

Work Location: In person

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