Creates and assists with the preparation of referral requests. As part of the preparation process will verify eligibility, benefits, request any needed clinical notes and accurately complete or forward referral to appropriate staff to finalize decision. Ensures that all referral policies and procedures are followed as required to meet all contractual, regulatory and federal requirements.
Essential Functions and Responsibilities of the Job
Research and process incoming referral requests and CRM’s received via fax or system generated
Check HP eligibility and benefits as needed
Gather clinical notes and HP criteria as needed
Scan and attach faxed clinical information
Demonstrate good problem-solving skills
Provide a high standard of customer service for Patients, Physicians and Staff
Demonstrate professional and courteous communication skills. Supports a collaborative and cooperative environment when working with others to facilitate mutual respect and effective interpersonal relations.
Assist providers, patients, other departments regarding issues related to referrals
Responsible for the coordination of PCC meetings, by preparing agenda, roster, distribution of reports, food orders, scheduling guests, scheduling meeting times and room preparation if work location is at clinic site.
Ability to prioritize and multitask with attention to detail and timeliness for task completion.
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.
Able to travel to other clinics to cover staffing needs and training.
Experience in Managed Care or Medical Field 1-2 years preferred. Familiarity with the interpretation of health plan benefit manuals and CPT/ICD coding, preferred.
Type with speed and accuracy, 40 - 50 wpm.
Must have excellent computer skills.
Excellent customer service skills and be a team player.
Must be dependable.
High degree of organizational skills.
Must be a High School Graduate/ or G.E.D or equivalent.
Medical terminology, preferred.
Internal Number: MEM003638
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.