The Referral Coordinator is responsible for handling all referral processing tasks from start to finish and creating protocols for referring providers, internal and external. This includes but is not limited to verifying patient insurance eligibility, communication with physicians, obtaining prior authorizations, process appropriate paperwork and is a back up to main patient support center team. The Referral Coordinator acts as a liaison between Adelante Healthcare and all External Referring providers, their office staff and patients.
Will observe policies concerning unscheduled absences and report unscheduled absences in accordance with departmental procedures, have six (6) or fewer occurrences of unscheduled absences in a twelve (12) month rolling period, and report to work at the start of the. Will comply with the organizational and departmental policies, and dress according to the dress code policy.
Every Adelante employee will strive to maximize their performance and contribution to Adelante Healthcare and the community we serve every day. Employees are expected work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism and competence.
OUR CORE VALUES
ESSENTIAL SKILLS AND EXPERIENCE
- High school diploma or GED from an accredited institution
- Minimum six months in a medical office team and/or approved development plan
- Demonstrated understanding of clinical methods and techniques used in record keeping systems.
- Advanced computer efficiency in Microsoft Office suite (Word, Excel, PowerPoint, Outlook) and experience in Patient Management System
- Professional written communication skills
- Ability to perform a variety of assignments requiring moderate exercise of independent judgment
- Regular and reliable attendance is an essential function of the position.
- Outstanding interpersonal, communication and team building skills required.
- Ability to work effectively in a fast paced environment. Organized, able to prioritize and work independently.
- Ability to speak in a clear and understandable manner and write legibly.
- Ability to meet and deal effectively with clients, associates, and patients
NONESSENTIAL SKILLS AND EXPERIENCE
- Possess a valid AZ drivers license
- Bilingual (Spanish and English)
- Joint Commission accreditation standards
- Prior coaching and monitoring experience is desirable and proven ability to interact with individuals at all levels of the organization
- Bachelors degree in Business Administration, Education, related field, or an equivalent combination of education, training and experience is required.
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job related selection or promotional criteria.
- Assure efficient patient flow is maintained. Assure compliance with internal procedures.
- Obtain patient information and enter accurately into computer system.
- Obtain prior authorizations and document referrals in the medical record
- Verify third party payer coverage and billing information-insurance, etc.
- Process an average of 35 referrals daily
- Maintain a working relationship with insurance plans/AHCCCS representatives and update coworkers on new developments as needed.
- Maintain communication with patients providing referral status.
- Ensure that all relevant information and the referrals are directed to the proper office.
- Document accurate phone messages for providers/staff and relay them promptly.
Additional Duties and Responsibilities
- Other duties as requested or assigned
- Travel to other sites
All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team based model to promote wellness and improve health outcomes.
Adherence to Compliance and Code of Conduct
All employees are required to comply with Adelante Healthcares written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelantes legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance, and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.
In any organization or job, changes take place over time. Although an effort will be made to keep job-related information current, this is not an all-inclusive list of job responsibilities. Adelante Healthcare, Inc. reserves the right to revise or change job duties and responsibilities as the business need arises. In compliance with EEOC 29 CFR part 1630, if the essential functions of this position cannot be performed in a satisfactory manner by the employee, further accommodations shall be made if it does not constitute undue hardships upon this organization.