Job description

Job Description

Eisner Health is seeking a referral coordinator to join our professional team. The role of the Referral Coordinator is to provide care coordination to support families entering the health care system and assisting with utilization and retention of benefits. The Referral Coordinator is responsible maintaining ongoing tracking and appropriate documentation on referrals. Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist. 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.

Duties:

•Processes patient referrals accurately and in a timely manner.

•Reviews request for authorization for completeness and sends to IPA or County (RPS), if appropriate, in a timely manner.

•Follows up on status of request for authorization and obtains approval in a timely manner.

•Works with referring provider to resolve denials or question regarding referrals.

•Contacts specialty clinic to assist patient in obtaining timely appointment for their visit.

•Informs referring provider and obtains order for addition test(s) requested by the specialist. Obtains authorization for additional test(s) if needed.

•Provides patients with accurate information regarding referral including name of specialty provider, address, directions, date and time of appointment, telephone number and a copy of the referral, if appropriate.

•Enters all referral activity in referral tracking system (i2i system, EPM or EHR), including events, notes and any relevant information as it relates to the referral.

•Evaluates referral request for eligibility, benefit determination, preferred provider networks.

•Works aggressively with physicians and physician office staff to obtain necessary medical information relating to the referral.

•Meets or exceeds Referral Department productivity targets on a weekly basis.

•Maintains files and records of all referral activity.

•Ensures integration of Referral Management activities with other areas of compliance, case management and Quality Improvement.

•Assists with training of new personnel.

•Participates in the joint and coordinated actions of the referral coordination team.

•Demonstrates initiative, motivation, and resourcefulness in day to day operations.

•Attends meetings as requested by supervisor.

•Follows up on referrals in a timely manner, no follow up should be over due by 10 business days.

•Calls or mails patient authorizations, referrals, and appointments in a timely manner.

•Reviews follow ups using i2i follow up report daily.

•Reviews referral process using i2i manage referral report daily.

•Assists with cross coverage with referral management team as assigned.

•Demonstrates initiative, motivations and resourcefulness in day to day operations.

•Submits productivity reports to direct supervisor weekly.

•Attends one on one monthly meeting with direct supervisor.

•Attends HCLA quarterly meetings.

•Attends monthly RPS meetings.

•Attends any meetings as directed by supervisor. Meetings may be held at other outside facilities.

•Performs other duties as assigned by direct supervisor

Requirements:

•Spanish speaking.

•Available to work evenings and weekends.

•High School graduate or Equivalent.

•Shows proof(s) of documentation of training or certification his/her particular field.

•At least (1) year experience with patient referral process.

•Knowledge of managed care plans and requirements.

•Knowledge of CPT and ICD-9 codes.

•Capable of handling and maintaining confidential information in a professional manner.

•Bilingual in English/Spanish.

•Demonstrates strong written & verbal communication skills.

•Demonstrates attention to detail.

•Knowledge of State and County programs including eligibility requirements.

•Proficient in Microsoft Office including Outlook, Word and Excel.

•Must be able to gather and analyze information skillfully.

•Must exercise good judgment.

•Must be able to identify and resolve problems in a timely manner.

Benefits:

• Health insurance
• Dental insurance
• Vision insurance
• Paid time off

Job Type: Full-time

Pay: $18.00 - $23.00 per hour

Experience:

• Referral Coordinator: 1 year (Required)

Language:

• Spanish (Required)

Work Location: In person

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