Referral Coordinator

Why Join Primary Care Partners? We Take Care of You While You Care for Others

At Primary Care Partners, we believe that taking care of our team is just as important as taking care of our patients. That's why we offer:

• 100% Employer-Paid Health Insurance Premiums – Your health matters to us.
• Paid Vacation and Sick Time – Because rest and recovery are essential.
• • A Strong Commitment to Work-Life Balance – We strive to create a positive, supportive environment where every individual can thrive both professionally and personally.

Referral Coordinator

Job Summary:

Primary Care Partners is dedicated to providing the most exceptional primary care services to our patients. To accomplish this goal, we continuously promote advancements in clinical practice and the utilization of state-of-the-art technology benefiting both patients and employees.

We are seeking a Referral Coordinator to join our team This position is primarily responsible for the tracking of outstanding patient referrals and follow up calls to patients to secure an appointment, the maintaining of referral folders including archiving, entry into patient accounts, and providing direct communication with referring provider offices on status on pending referral requests. This position will also support the Prior Authorization team.

Essential Duties and Responsibilities Referral Coordinator:

• Collaborating as a team to distribute and execute daily work flow, as well as coordinate planned time off to ensure adequate workflow coverage.
• Sign on and be proficient in the following software: Citrix, Paycom, Spark, Veradim, Altera Electronic Health Record (EHR), faxes, Phreesia, econsults, and general knowledge of filling out forms for Childfind etc on the internet
• Check faxes, tasks, listen to vm, check worklist, and referral loop
• Prioritize all presented workflow, following HIPPA regulations.
• Complete the worklist- according to protocol time constraints, send ASAP/STAT first, task staff & providers for changes or clarification, create summary of care, annotate in chart , fax referrals, check fax system for completion for Primary Care Partners (6 offices, 66+ providers, to over 1000 specialists/offices). Follow STAT referrals to point of scheduling.
• Send tasks to Prior Auth team if pt needing referral has UCH or Tri-care insurance to make sure referral has been prior authorized before pt is seen.
• Altera EHR tasks-monitor tasks throughout the day, and respond to tasks in a timely manner, with accurate and complete annotation in charts
• Monitor voice mail throughout the day and respond to patients/families, staff, providers, and specialists offices. Calls prioritized according to stated needs. Communicate with involved parties through phone, patient portal, or EHR tasks. Annotation entered into EHR chart.
• Submit Child Find 0-3 yrs on state internet website.
• Follow RMHP EConsult program and attach documents as needed for providers as well as submit consult to billing.
• Complete the colonoscopy/EGD worklist

Prior Authorization Specialist:

• Verifies insurance eligibility and benefit levels to ensure adequate coverage for identified services prior to receipt.
• Successfully works with payers via electronic/telephonic and/or fax communications.
• Responsible for verification and investigation of pre-certification, authorization, and referral requirements for services.
• Coordinates and supplies information to the review organization (payer) including medical information and/or letter of medical necessity for determination of benefits.
• Collaborates with designated clinical contacts regarding encounters that require escalation to peer-to-peer review.
• Communicates with patients, care team, financial counselors, and others as necessary to facilitate authorization process.
• Appropriately prioritizes workload to ensure the most urgent cases are handled in a timely manner. Completes accurate documentation of Auth/Cert.
• Completes notification to all payers via electronic/fax/telephonic means per policy.
• Ensures timely and accurate insurance authorizations are in place prior to services being rendered.
• Follows departmental policies and procedures when necessary authorization is not obtained prior to service date.
• Answers provider, staff, and patient questions surrounding insurance authorization requirements. Discuss any insurance communication with patient or family members.
• Registering referrals

Miscellaneous:

• Attend collaborative monthly team meetings, focused group meetings, and trainings as available.
• Collaborate with providers, staff, patients, families, and specialists offices to trouble shoot barriers to obtaining referral acceptance.
• Complete referral loop for all referrals.
• Pilot special projects for PCP IT, Phressia, and RMHP.
• Collaborate and cooperate with referral team, office managers, care coordinators, chronic care coordinators, and prior authorization team to optimize work processes.
• Identify patients' insurance needing prior authorization, and tasking prior authorization team.
• Communicate with triage, providers, back office staff regarding issues and changes needed for a referral. Annotating changes in chart.
• Generating and editing referrals as needed.
• Produce and organize a quarterly newsletter with information pertinent to the efficient referral workflow, distributed to all providers and back office staff.

Work Experience:

One-plus years of hands-on experience in computer data entry. One plus years of applied knowledge in managed care environment and solid working knowledge of medical terminology.

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