Bright HealthCare
SCOPE OF ROLE
The role of the Referral Coordinator is to facilitate consistency of information shared across practices to promote care coordination and effective member co-management for behavioral and non-behavioral practitioners. The Referral Coordinator collaborates with clinical team members to evaluate the potential over and underutilization of specialty services based on clinical protocols.
ROLE RESPONSIBILITIES
- Prioritizes assigned patient cohorts to ensure specialty referral completion and ensures stat and expedited referrals are completed based on timeliness standards
- Schedules patients (Preferred Providers List of Specialists) and notifies them of appointment information, including, date, time, location, etc.
- Ensures missed specialty appointments are rescheduled and communicated to the physician/clinician.
- Ensures specialist notifications of referral status
- Completes exchange of information by retrieving and ensuring upload of specialty consultation and follow-up notes
- Completes documentation based on standardized documentation; to include, but not limited to location, notification of specialist, notification of patient, the status of appropriateness reviews
- Enters all Inpatient and Outpatient elective procedures in EMR and contacts specialist for post-procedure referral needs
- Follows up on all Home Health and DME orders to ensure the patient receives the services ordered.
- Completes appropriateness review based on clinical protocols and appropriately refers to Nurse or Medical Director
- Addresses referral based phone calls for the Primary Care Physicians panel and completed phone messages timely
- Facilitates escalation of denied referrals to the clinical team for appeal reviews.
- Adheres to the Policies and Procedures set forth by the Quality Management Committee.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- High School Diploma
- Minimum 2 years of experience in medical management.
- Capacity to interpret health plan benefit decisions
LICENSURES AND CERTIFICATIONS
- Certification as a Medical Assistant preferred
WORK ENVIRONMENT
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Some travel may be required.
- Ability to lift at least 50 pounds.