Referral Coordinator Clinical- Care Coordination
: Job Details :

POSITION SUMMARYAs a Clinical Referral Coordinator, you will play a vital role in our healthcare team, dedicated to delivering the highest quality of patient support. This position is responsible for the seamless coordination of provider specialty referrals from start to finish, ensuring exceptional customer experience and meticulous stewardship. Your key responsibilities include providing friendly, rapid, and accurate patient support, completing patient registration documentation, and assisting with various departmental projects and clerical duties. Your contributions will directly impact patient care and satisfaction, making you an essential part of our commitment to No Harm/Quality and outstanding service.PRIMARY ACCOUNTABILITES* Receive and process referral requests from physicians, clinics, and other healthcare providers.* Verify the accuracy and completeness of referral information, including patient demographics and insurance details.* Ensure referrals are directed to the appropriate specialist or department based on medical necessity and provider availability.* Schedule and coordinate appointments to align with patient and provider availability, minimizing wait times.* Utilize in-depth knowledge of insurance policies, payor plans, par (participating) and non-par (non-participating) status, copays, and coinsurance to accurately process and manage patient referrals.* Ensure all referrals are compliant with insurance requirements, verify patient eligibility, and maintain up-to-date records of insurance policies and payor information to support efficient and accurate referral processing.* Confirm appointment details with patients and provide necessary instructions for their visits.* Contact patients to inform them of referral status, appointment details, and any required pre-appointment preparations.* Communicate with insurance companies to resolve any issues or discrepancies related to coverage and authorizations.* Maintain accurate and up-to-date records of all referrals, appointments, and communications.* Work closely with healthcare providers, medical assistants, and administrative staff to ensure smooth referral processes using clinical knowledge and training.* Monitor referral and scheduling processes to identify areas for improvement.* Other duties as assigned.MINIMUM QUALIFICATIONS* Education: High school diploma or equivalent.* Work Experience: 1-3 years experience in a call center, customer service, or healthcare setting.* Licensure: MA Certification* Certification: Medical terminology.* Skills/Knowledge/Abilities:* Extensive knowledge of healthcare terminology and abbreviations, previous healthcare experience is preferred.* Compassionate and patient-focused approach to customer service.* Strong organizational and multitasking abilities.* Proficient in Microsoft Office Suite (Word, Excel, Outlook) and comfortable using electronic health record (EHR) systems.* Ability to work effectively in a fast-paced, high volume call center environment and meet performance metrics.* Detail-oriented with a strong focus on accuracy and quality.PHYSICAL REQUIREMENTS* Majority of time involves sitting or standing; occasional walking, bending, stooping.* Long periods of computer time or at workstation.* Light work that may include lifting or moving objects up to 20 pounds with or without assistance.* May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise.* Communicating with others to exchange information.* Visual acuity and hand-eye coordination to perform tasks.* Workspace may vary from open to confined; on site or remote.* May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.