Referral Coordinator Lead

General Description:

The Lead Referral Coordinator supports the Supervisor of Medical Referrals in executing the department’s vision and expectations.  In the absence of the Supervisor of Medical Referrals, the Lead Referral Coordinator will stand in proxy, providing oversight, guidance, and direction. The Lead Referral Coordinator will assist the Supervisor of Medical Referrals in completing evaluations, corrective actions, and training and development of staff. In addition, the Lead Referral Coordinator functions as the primary liaison between the primary care physician (PCP) team, patient, and external referral specialist.  Duties include setting up appointments with external referral specialists and processing insurance authorizations to ensure timely start of services, as well as tracking, monitoring, and retrieving results.  This position must be executed in compliance with insurance requirements, and the coordinator will often work closely with insurance companies.

Minimum Requirements:

1. Associates degree or 2 years of referral experience
2. Medical Assistant training preferred.
3. Extensive knowledge of, and experience with the entire referrals process.
4. Ability to establish and maintain effective working relationships with other employees, patients, representatives of outside agencies and the general public.
5. Professional mannerisms and appearance.
6. Excellent communication skills (verbal and written).
7. Superb computer skills and the ability to master the EPIC OCHIN electronic medical record.
8. Current HIPAA training.

Responsibilities:

Referrals:

1. Review referral, PCP notes, verify patient insurance information, patient address, and phone number and update system as necessary.
2. Work with the PCP to ensure all required information is available for referral processing.
3. Fax all appropriate pertinent referral information i.e., history and physical, labs last office visit and referral information to the specialist (minimum necessary according to HIPAA).
4. Schedule outside referral appointment based on insurance type, as directed by PCP.
5. Accurately submit and obtain prior authorizations as required based on type of service and insurance.
6. Notify patients of options available to book specialist appointments when insurance is not available or prior authorization denied and actions they may need to take directly with the specialist.
7. Consult with the provider as required to communicate status of referrals.
8. Acccurately document all referral details and actions taken in the EHR such as the location of appointment, name of specialty office, date of appointment, special instructions etc.
9. Inform patients of scheduled appointment information via mail/phone/WELL.
10. Retrieve specialist notes and reports from the fax server, PVIX, Baystate, Mercy, or similar systems once patient completes specialty appointments, ensure uploading into the EHR notify the provider and close referral.
11. Conduct routine follow-up with specialty practices on outstanding referral reports.
12. Run reports to monitor current open and booked referral volumes requiring action and communicate to management status as required.

Other Duties:

1. Answer phone calls and support all inquiries directly or redirect accordingly.
2. Perform general office duties that require proficiency in communication and organizational skills.
3. Check referral voicemails regularly; address referral requests appropriately.
4. Provide premier levels of customer service keeping the customer first at all times.
5. Problem solving skills required.
6. Maintain patient privacy and confidentiality.
7. Adherence to HIPAA regulations.
8. This position requires the ability to work at a computer workstation.
9. From time to time, this positiona also requires the ability to work long and arduous hours.
10. Support the agencies accountable care organization (ACO) partnership by focusing on providing high quality and value for patients.
11. Other duties as assigned.

Lead:

1. Review and manage data analytics for the department and generate reports, identify trends and gaps and implement systems of improvement.
2. Implement or incorporate a performance dashboard by referral coordinator and the department as a whole that is transparent, clear, and concise.
3. Provide weekly data driven report out on department performance, setbacks, achievements, and concerns.
4. Maintain a current, complete, electronic workflow that is easily accessible and available to all referral staff in real time in a shared cloud based location including videos.
5. Conduct and record trainings regularly to ensure standardization and efficiency across the department.
6. Identify training gaps within the department and implement audits, assessments, training plans, and benchmarks to ensure closure of gaps.
7. Proactively identifies areas of opportunity to enhance within the department and ensures compliance with HRSA 18 Core Requirements, CMS regulations, other regulating bodies and the agencies strategic vision.
8. Responsible for fostering a positive environment of accountability and excellence.

Working Conditions:

1. This position requires prolonged periods of sitting at a desk and typing on a computer; ability to stand for prolonged periods of time; ability to perform moderate activities such as climbing stairs, bending, stooping, reaching, and lifting up to 20 pounds at times; and potential exposure to adverse outdoor environmental conditions.