Referral Coordinator

Description

Title: Referral Coordinator

Location: Fountain Valley, CA

Department: Ambulatory UM North

Status: Full-Time

Shift: Days (8hr)

Pay Range*: $20.75/hr - $29.47/hr

At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare.Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability.Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.

Position Summary

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.
• Meet all department standards
• Responsible for running daily reports to capture all work stream referrals including; urgent referrals, ASA referrals, portal referrals and indemnity/PPO submissions, ODAG reports and other requested ad hoc reports for utilization, productivity and operational metrics.
• 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 be at work on time
• Ability to follow company policies, procedures and directives
• Ability to interact in a positive and constructive manner
• 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.
• Telecommuting (full or part time) may be an option and is based on business necessity, functional area, productivity measures and availability of resources. Administration of this option will be in line with Telecommuting Policy, Reference # HR344."
• Able to travel to other clinics to cover staffing needs and training.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there's moreCheck out our MemorialCare Benefits for more information about our Benefits and Rewards.

Qualifications

Minimum Requirements

Qualifications/Work Experience:

• 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.

Education/Licensure/Certification:

• Must be a High School Graduate/ or G.E.D or equivalent.
• Medical terminology, preferred.