POSITION SUMMARY 

This position monitors and processes referrals and orders submitted by St. Joseph Clinic providers. Referral Coordinators are responsible to work referrals and orders from assigned clinics/departments, as well as provide back-up to other clinics/departments as needed to accommodate the needs of the organization. Primary responsibilities include timely monitoring and processing of tasks in the buckets/inboxes within the EMR and corresponding related activities such as sending medical records, contacting payers, and collaborating with internal and external providers and healthcare entities. Referral Coordinator confirms accuracy of each order prior to submitting to the payer for processing. This may include use of medical necessity check (i.e., Code Check in Athena), payer policies, and/or other resources and tools. Documentation of all activities will be done within the EMR and in accordance with adopted workflows and protocols. This position represents the organization through interactions with both internal customers (healthcare providers and staff), external customers (other healthcare organizations & payers), as well as our patients. Excellent, professional written and verbal communication skills are needed to successfully perform the duties of this position. 

PRIMARY DUTIES:

• Process Provider-to-Provider/Provider-to-Payer Referrals & Authorization
  • Review orders for accuracy, follow payer/provider requirements, document actions taken, collaborate with office staff and provider as needed to expedite patient care. 
  • Maintain working knowledge of payer requirements, including state and federal payers. 
  • Ensure efficient, timely, and accurate submission of referrals and report issues to supervisor as needed to communicate problems and/or delays. 
  • Submit referrals and any required supporting documentation to payer and/or provider of services for assigned clinics, working from the Clinical In-box referral buckets, promptly and appropriately for services requested.
  • Document required referral information in EMR, including any applicable authorization numbers, services, or dates covered in accordance with adopted workflows and protocols.
  • Work within departmental goals established for timeliness of processing order requests.
• Process Prior Authorization for Procedures/Services ordered and/or performed by St. Joseph Clinic Providers
  
  • Review orders for accuracy, follow payer requirements, document actions taken, collaborate with office staff and provider as needed to expedite patient care.
  • Maintain working knowledge of payer prior authorization requirements, including state and federal payers. When changes are identified share with supervisor and referrals team.
  • Submit prior authorizations and any required supporting documentation to payers promptly. Utilize electronic options via payer website whenever possible. 
  • Document actions and all applicable referral information (i.e. CPT, ICD-10, # of visits, coverage period, PA # etc.) into the EMR. Ensure any correspondence received from payer regarding approval or denial is also scanned into the medical record.
    
    
• Internal and External Customer Service
  • Professionally represent the organization and your department by working collaboratively with St. Joseph Clinic & hospital providers and staff to expedite patient care and access to services. 
  • Collaborate with external healthcare providers, staff, & payers to expedite patient care while representing the organization in a positive & professional manner.
  • Various tasks, including those not listed on this job description that are inherent to the position and referral process with payers, patients, and providers. 
• Collaboration with Stakeholders
  
  • Relay information, discuss and investigate issues, questions, and concerns with all necessary parties (patients, staff, providers, insurance carriers, other healthcare providers, and/or internal SJRMC departments) 
  • Share new information as appropriate and in coordination with Manager and/or Lead to ensure clear, concise messaging.

GENERAL POSITION INFORMATION
This is a non-exempt position. Schedule will vary based on departmental needs. The workload is produced by the number of referrals and prior authorizations submitted. The position contributes directly to the ability of patients to receive timely access to necessary care and services. Tasks must be prioritized and in accordance with adopted expectations of timeliness while maintaining a positive working relationship with the public, physicians, co-workers and other Medical Center staff. Must maintain a high level of professionalism, integrity, work ethic, and proceed with a minimum level of supervision.

LICENSE, EDUCATION & EXPERIENCE

Required: 
• High School Diploma or equivalent 
• Minimum 3 years working in relevant healthcare position

Preferred: 
• Prior experience working as a referral coordinator
• Certification in billing or coding

WORKING CONDITIONS

Work environment is a typical office setting with no hazardous duties. Remote work may be offered by manager approval, provided employee has access to a private, HIPAA-compliant workspace. All state, federal and organizational privacy and security policies must be adhered to when working remotely. 
Moderate lifting is required on occasion when moving items from one place to another. Stooping and bending may be required in the course of your working day. Good vision is required for reviewing documentation. Attention to minute detail is required. Good motor coordination and finger dexterity are required to operate equipment, perform computer data entry and to process paperwork.