Match score not available

Referral Coordinator

Remote:

Full Remote

Contract:

Full time

Experience:

Mid-level (2-5 years)

Work from:

Canada

Offer summary

Qualifications:

High School Diploma required, Two years experience in referral management or call center, Certified Medical Assistant preferred.

Key responsabilities:

Process and pend referral requests timely
Complete daily referral assignments via various methods
Maintain documentation in IDX system accurately
Handle stat calls and customer communications
Assist with special projects as assigned

Prospect Medical Systems SME https://prospectmedicalsystems.com/

501 - 1000 Employees

See more Prospect Medical Systems offers

Job description

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 Education: High School Diploma required.

Minimum Experience: Minimum of two (2) years of experience with Referral Healthplan, IPA or Medical Provider office with referral management and/or call center knowledge.

Req. Certification/Licensure: Certified Medical Assistant preferred.

"Location-Based Pay Adjustment"

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.