Pace Referral Tracking Coordinator

The PACE Referral Tracking Coordinator (RTC) I is responsible for the processing of all medical referrals initiated by NEMS PACE providers from start to finish, which includes verifying patient's eligibility and coverage information from various insurance plans, obtaining prior authorizations when needed, communicating with hospitals and specialty providers' offices to follow up referral requests, confirming completion of visits by obtaining consultation notes, documenting progress in Epic EHR system to keep PCPs and care team informed. The PACE RTC-I is responsible for the tracking of all the in-progress medical referrals and performing additional needed activities to ensure referrals initiated by PACE providers are followed through according to TAT (Turnaround Time) requirement.

This position requires good communication and public relations skills to build rapport and relationships with counterpart staff at external specialist offices and hospitals to facilitate a smooth close-the-loop process. The PACE RTC I will work collaboratively with NEMS call

center and clinical team, external provider/vendor offices and hospital staff to promote workflow efficiency and team performance.

ESSENTIAL JOB FUNCTIONS:

• Timely processing of medical referrals for PACE insurances according to PACE program requirements.
• Obtain clinical information relevant to the patient's referral and submit a complete packet of referral documents, including the approved Prior Authorization when appropriate, to external provider's office to avoid delays in patient care.
• Track referral status and obtain consultation reports/results to close the referral loop when needed.
• Follow-up on the outstanding referrals report and contact PACE care team to determine if patients still need/want the requested service.
• Provide PACE care team with accurate information regarding the referral, including specialty type, name of the specialty provider, address, phone number, and a copy of the referral, if appropriate.
• Triage inquiries on referral status and communicate timely with the PACE care team if additional information is needed to process the referral.
• Enter all referral related activities and communications in the patient's Electronic Medical Record, including notes and any relevant information as it relates to the referral.
• Performs other job duties as required by manager/supervisor