TrueCare is a trusted healthcare provider serving San Diego and Riverside Counties, offering compassionate and comprehensive care to underserved communities. We are committed to making healthcare accessible to everyone, regardless of income or insurance status. With a focus on culturally sensitive, affordable services, TrueCare aims to improve the health of diverse communities. Our vision is to be the premier healthcare provider in the region, delivering exceptional patient experiences through innovative, integrated care.
The Referral Coordinator is responsible for the coordination, processing, obtaining prior authorizations, and requesting reports for a variety of medical referrals for services/procedures as requested by medical providers. The Referral Coordinator will also collaborate with other referral staff, medical providers, and patient care support staff to effectively communicate and ensure successful tracking and coordination of referrals.
Responsibilities:
•Gathers pertinent information as needed via EHR or from clinical team to accurately complete pre-authorization/referral process.
•Prepares and accurately processes referral and pre-authorization paperwork; ensures that referrals are addressed in a timely manner, prioritizing urgent items appropriately.
•Verifies insurance information and performs eligibility checks by telephone or electronically, as appropriate, for referral purposes.
•Produces and submits all appropriate notification letters for patients and clinicians, as required.
•Ensure complete tracking and follow-up on all referral requests and specialty report requests.
•Answers, responds and documents phone calls, requests and questions from patients in a timely manner; reviews details and expectations about referrals with patients.
•Responds to clinical support staff questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.
•Utilizes third party payer/insurance portals as needed.
•Ensures proper use of Current Procedural Terminology (CPT) and current International Classification of Diseases (ICD) codes to meet the requirements of third party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations. Follow-up with clinicians as needed.
•Responsible for proper documentation according to TrueCare protocols.
•Utilizes EHR functions and/or other software systems to document all pertinent referral or Patient Health Information (PHI).
•Schedules referral appointments directly on behalf of patients, as needed.
•Tracks referrals utilizing the EHR or other established system.
•Properly follow-up with provider and patient regarding denials to referral requests.
•Cross trains with other Referral Coordinators to learn each process related to the various service lines provided by TrueCare completely to ensure coverage is available.
•Maintains confidentiality of PHI by following all applicable Health Insurance Portability and Accountability Act (HIPAA) regulations.
Qualifications:
•High school diploma or equivalent.
•At least one year of experience as a Medical Receptionist or Medical Assistant (MA) in an outpatient setting, or in medical case management.
•Bilingual in English and Spanish.
•Knowledge of medical terminology and procedures, and CPT and ICD codes.
•Availability to work outside of normal shifts (i.e., 8am to 5pm and on Saturdays).
•Computer literacy working with PC-based software applications and proficiency with the Microsoft Office suite, including Outlook, Word and Excel.
Preferred Qualifications:
•Two years of referral coordination or medical assisting experience.
•Understanding of insurance providers, their portals and their expectations for authorization approvals.
•Medical Assistant certification.
•Experience working in a community health center.
•Working knowledge of EHR and registration/billing software.
Benefits:
- Competitive Compensation
- Competitive Time Off
- Low-cost health, dental, vision & life insurance
Skills Required
- High school diploma or equivalent.
- At least one year of experience as a Medical Receptionist or Medical Assistant in an outpatient setting, or in medical case management.
- Bilingual in English and Spanish.
- Knowledge of medical terminology and CPT and ICD codes.
- Availability to work outside normal shifts, including Saturdays.
- Computer literacy with PC-based software and proficiency with Microsoft Office (Outlook, Word, Excel).
What We Do
As a nonprofit community health center, TrueCare is dedicated to delivering a superior and compassionate healthcare experience, reducing barriers and increasing accessibility to quality care for diverse communities.
