Referral Coordinator

Job Description

The Referral Coordinator prepares referrals and address stat line requests. Complete daily tasks/queues as assigned. Assist the Referral Nurse and Medical Directors daily with additional information needed for completion. Document pertinent information in Aerial Comments and IDX referral system. Special projects as assigned.

Responsibilities

Process referral requests received and assigned referral queue using Auto Approval List. Pend nurse and Medical Director review to appropriate referral requests timely to ensure compliance is maintained. Complete daily referral assignments received by fax, phone or portal etc.|Documents all pertinent information in IDX to include medical notes, benefit information, contracted vs non contracted provider. Accurate data entry into IDX fields.|Maintain timeliness standards by regulatory requirement for each product line.|Maintain daily production standard based on corresponding assigned job duties set by department manager. Handle stat calls for assigned team on a daily basis and adhere to department standards for coverage. Answers all voice mail at least every hour and respond to messages within 24 hours to ensure customer satisfaction is maintained. Alert Nurse Reviewer of expedited requests.|Provide notifications to providers and members within 24-72 hours or by regulatory requirements. Assist providers, patients and internal and external customers regarding issues related to referrals. Special projects as assigned which may include CCS, OIG, Unused/Expired, Fax Failure, IHA, NOMNC etc. Perform any additional duties that may not be inclusive in job description as requested by Management team that is within the scope of knowledge or ability of the Referral Coordinator.

Qualifications

Minimum of two (2) years of experience with Referral Healthplan, IPA or Medical Provider office with referral management and/or call center knowledge.High School Diploma required. Certified Medical Assistant preferred.

"Location-Based Pay Adjustment"