The Referral Coordinator is responsible for assisting the providers with patient referrals. Employees are hired with an expectation to help R Family Medical Group carry out its mission of serving the San Antonio Community with the highest quality of care while improving patient’s healthcare outcomes.
Employees are expected to exhibit a continuous behavior of professionalism, which includes but is not limited to: treating patients and co-workers with respect and dignity, aligning behavior with customer service principles, maintaining customer and patient confidentiality, abiding by employee guidelines for professional behavior, appearance, and communication, exhibiting teamwork behaviors, being effective in conflict resolution, helping others to understand issues and accept changes, demonstrating high standards of work performance and flexibility, maintaining positive interdepartmental relationships, keeping a positive attitude, and adhering to the policies and procedures of the organization.
Job Summary:
We are seeking a service-focused, professional, and dynamic Referral Coordinator to join our team! The ideal candidate for the role must demonstrate a strong background in healthcare and referrals and be adaptable, professional, and with excellent administrative skills. Responsible for making patient referrals to specialists for services not provided by R Family Medical Group providers. Serve as the primary contact for internal and external requests for information or assistance related to authorizations. Responsible for insurance prior authorization for specified orders and testing. Referrals and prior authorizations will be completed from all providers/sites at R Family Medical Group.
Job Duties
Greet all patients by:
- Addressing the patient by their formal name (Mr., Mrs., Miss) or as requested by the patient.
- Confirm the patient’s name of date of birth.
- Introduce yourself (state your name)
- Complete all referrals for the clinic or facility and ensure they are processed effectively, ensuring they are sent to the correct specialist or facility.
- Send out referrals to other facilities or service providers to be processed.
- Keep patients up to date with the status of their referrals.
- Establish, implement, and standardize the information-sharing procedures and systems for the clinic.
- Coordinate referrals with all relevant departments.
- Answer calls from patients/other departments to provide information and advice.
- Follow up on sent referrals.
- Keep the system/log up to date with any changes in information.
- Liaise with doctors, nurses, and other team members to ascertain wait times for specific referrals.
- The Referral Coordinator is responsible for all incoming authorizations, whether received on paper, by phone or electronic submission.
- Coordinates authorizations for referrals for patients to outside specialists.
- Prepares referral forms and transmits required information to specialists.
- Submits referral information to insurance companies for approval/authorization.
- Communicates with providers as needed to obtain additional or missing clinical documentation necessary for medical review.
- Manages appeals and coordinates with providers on next steps.
- Coordinates with providers and specialist to schedule urgent referrals for patients.
- Makes calls to patients or external agencies as needed and coordinates with professional staff for follow up and tracking of referral completion.
- Performs eligibility checks on members as necessary by telephone or electronically as appropriate.
- Provides great customer service for internal and external customers requesting information related to pending authorizations, authorization process or other related issues.
- Completes prior authorizations for procedures and testing that requires insurance authorization. Seeks out required clinical information from provider or nursing as required.
Competencies
At R Family Medical Group, it is essential that are employees demonstrate both hard and soft skills. The list below of hard and soft skills are what R Family Medical Group looks for and expects from our employees.
- Excellent customer service skills
- Ability to read, understand and follow verbal and written instructions.
- Ability to type and write clearly and correctly.
- Can establish and maintain effective working relationships with patients, employees and the public.
- Can de-escalate difficult interactions.
- Seeks appropriate help from supervisor or clinical staff to solve problems when appropriate.
- Ability to multi-task and maintain professional demeanor in a busy practice environment.
- Serves as a liaison between patients, physicians, and other support staff.
- Highly organized and able to prioritize work effectively.
- Good problem-solving skills
- Great attention to detail
- Good customer service skills
- Knowledge of data protection and patient confidentiality guidelines
Hard skills: indicate your experience and technical abilities.
Adept to using the following:
- Bilingual or multilingual
- Microsoft Office
- eClinicalWorks (electronic health record software) preferred.
Soft (people) skills: soft skills indicate your ability to work well with others and grow within the company. Can help you communicate effectively, demonstrate professionalism, and develop business relationships.
- Integrity
- Dependability
- Effective communication
- Open-mindedness
- Teamwork
- Creativity
- Problem-solving
- Critical thinking
- Adaptability
- Organization
- Willingness to learn.
- Empathy
Supervisory responsibilities - None
Work environment
Medical practice setting with office type workstation.
Physical demands
- Sitting, standing, and walking throughout the day.
- Stooping, bending, and stretching for files and supplies.
- Using computer screen for long periods of time.
- Occasional lifting of files or paper weighing up to 20 pounds.
- Manual dexterity sufficient to operate a keyboard, telephone, copier and other office equipment.
- Occasional stress from working with ill people patients and from many interruptions.
Travel required
Occasional travel to other R Family Medical Group locations may be required.
Required education and experience
- Minimum one-year medical office experience processing referrals
- High School graduate or GED
- Job experience that demonstrates an understanding of medical terminology
- Prior job knowledge and use of electronic medical records
Preferred education and experience
- Additional medical office experience (3 to 5 years)
- Bilingual Spanish speaking
- Demonstrated understanding of industry guidelines and best practices
This job description is a general description of job functions. It is not intended as an employment contract, nor is it intended to describe all duties someone in this position may perform. All employees of R Family Medical Group, Inc. are expected to perform tasks as assigned by R Family Medical Group, Inc., supervisory/management personnel, regardless of job title or routine job duties. In accordance with the American with Disabilities Act, R Family Medical Group, Inc., will provide reasonable accommodations for individuals who can perform the essential functions of this job.
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee discount
- Flexible schedule
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Referral program
- Vision insurance
Weekly day range:
- Monday to Friday
- Weekends as needed
Education:
- High school or equivalent (Required)
Experience:
- Insurance verification: 1 year (Preferred)
- Medical terminology: 1 year (Preferred)
Work Location: In person