Website Borrego Health
Summary: Referral Care Coordinator plays a key role as part of the clinical team. The referral clerk is responsible for assuring continuity of care for those patients with a referral order, by coordinating timely specialty or ancillary appointments. The referral process is a multistep process and the referral care coordinator is responsible to make sure that the process is following its course. The referral care coordinator works as a liaison between the primary care provider, insurance companies, specialty providers, diagnostic services, and patient(s). The Referral Care Coordinator is responsible for data entry of referrals information and documentation of all referral interventions.
Essential Duties and Responsibilities:
- Process referrals according to level of urgency.
- Data entry of all new referrals into the i2i referral module; documentation of all interventions to include, date and time.
- Documents necessary information pertaining to the referral order in the patient’s chart or EHR
- Submits authorization to insurances, tracks the status of the authorization. Once approved, documents procedure approval number and authorization period in the referral tracking system.
- Coordinates between patient and specialty provider to schedule appointment. Provides special instructions if needed.
- Communicates with primary care provider to inform of any delays or barriers to care
- Communicate with patient if any delays in scheduling appointment
- Monitors patient compliance and re-schedules appointments as needed
- Responsible to track reports and to make sure that all reports are received in a timely manner. Close referrals once the report is received
- Works with the Primary Care Provider to work on re-processing authorization denials
- Case Management of more complex cases, with the end goal of scheduling timely referral appointments.
- Manage referrals at every stage to avoid backlog.
- Collaborate with Care Coordinator Specialist to identify patients that could benefit from program enrollment due to their conditions or needs.
- Comply with referral management policy.
- Send letters to patients when unable to reach by phone; handle all returned letters.
- Handle all incoming calls for the department in a courteous manner; provides callers with an answer to their questions as best as possible.
- Seeks assistance of supervisor when unable to process all referrals to avoid backlog and the clinical consequences of delays.
- Provides quality care to the patients of Borrego Health, within the scope of practice outlined by state or federal law.
- Delivers care in accordance with established standard of care and accepted community standards.
- Understands the organizations commitment to provide high quality patient care. Promotes a Patient centered environment.
- High school diploma or GED Equivalent.
- Three years medical field experience with understanding of insurance and medical terminology
- All staff that is presently working within a clinic is required to have a Current and Valid CPR and First Aide certification on file with the Human Resources Department. This is for clinical and administrative staff. This new license requirement is mandatory for continued employment, CPR and First Aide certification must be obtained though the American Heart Association. Internet certificates do not comply and for this reason are not valid.