The Referral Coordinators within SAMG is responsible for serving as a specialist in the coordination of all aspects of specialty referrals; both incoming and outgoing, eligibility verification, and maintenance for outpatient clinic patients. This responsibility includes obtaining client information, maintaining patient files, verifying information with appropriate agencies, and reporting statistics and data as required. Obtaining referrals while assisting providers, staff, and patients with referral related questions. Verification of coverage and correct documentation within the patient medical record to complete the referral process thoroughly within the EMR system. Referral Coordinator will complete internal SAMG referrals according to the patient’s benefits. Referral Coordinator will ensure process is completed accurately through each work queue to adhere to all governing federal regulations and SAMG policies.
SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:
High school diploma or equivalent, Associate degree preferred
1 year of healthcare related referral experience required, 3 years preferred
ESSENTIAL FUNCTIONS:
Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions.
Serves as a specialist in processing and approving selected specialists referrals according to policy and procedure established by the Network in general and SAMG specifically.
Obtains referral request documentation.
Maintains ongoing tracking through an EMR system and appropriate documentation on referrals within the three work queues that are assigned and closing the loop.
Demonstrates a high degree of accuracy and timeliness in completing referral authorizations.
Compiles all pertinent medical data and supporting documentation and faxes or mails to appropriate receiver. Directly communicates with referring provider offices to request missing documentation and/or updates regarding delays in contacting the patient.
Verifies eligibility, benefits and contractual appropriateness. Verifies all documentation is received from referring provider office.
Acts as liaison between practice, patients, referral sources, and health insurance companies to resolve complaints and problems.
Serves as expert internal consultant to all levels of practice staff.
Monitors, resolves and updates the status of problem authorizations.
Assembles information concerning patient's clinical background and referral needs. Per referral guidelines through their specific insurance plan, provide appropriate clinical information to specialist. Schedules diagnostic tests (if necessary) prescribed by Specialist provider to be completed prior to New Patient Appointment.
Contacts review organizations and insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis and prognosis.
Ensures that referrals are addressed within a timely manner.
Responsible for recording information within referral in order to assist in the tracking of referral and to assist and ensure follow-up.
Ensures that patient's primary care chart is up to date with information on specialist consults related to their health.
Reviews details and expectations about the referral with patients.
Responsible for training and orientation of new Referral Coordinator’s into practice.
Trains new Referral Coordinator colleagues on current policies and procedures as needed.
Continually maintains Health Insurance Portability and Accountability Act (HIPAA) and other compliance requirements.
Enters non-clinical information into patient electronic medical record (EMR system). Ensures all required information is keyed in thoroughly and accurately.
Views non-clinical information in EMR system.
Independently formulates information to be entered into EMR.
Obtains information to be entered from multiple sources such as providers, nurses, etc.
Logs, tracks, and resolves issues within specific timeframe to ensure accuracy and timeliness of data entry.
Brings errors and/or issues to the attention of designee.
Identifies and utilizes cultural and community resources. Establishes and maintains relationships with identified service providers.
Navigates through multiple complex EMR screens and enters data.
Reminds patients of scheduled appointments via EMR system, by mail, or by phone.
Performs other duties as assigned to include back up PSR coverage when necessary.
Colleagues of Saint Alphonsus Health System enjoy competitive compensation with a full benefits package and opportunity for growth throughout SAHS and Trinity Health!
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Saint Alphonsus and Trinity Health are committed to promoting diversity in its workforce and to providing an inclusive work environment where everyone is treated with fairness, dignity and respect. We are committed to recruit and retain a diverse staff reflective of the communities we serve. Saint Alphonsus and Trinity Health are equal opportunity employers and prohibit discrimination against any individual with regard to race, color, religion, gender, marital status, national origin, age, disability, sexual orientation, or any other characteristic protected by law.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.