Job Summary:
The role of the Referral Coordinator is to collaborate with patients by assessing, facilitating, planning and advocating for health needs on an individual basis. Successful outcomes cannot be achieved without specialized skills and knowledge applied throughout the process. These skills include, but are not limited to, positive relationship building, effective written/verbal communication, ability to affect change, perform critical analysis, plan and organize effectively and promote client/family autonomy. It is crucial for the Referral Coordinator to have knowledge of funding resources, services and clinical standards and outcomes
Responsibilities:
- Maintain ongoing tracking and appropriate documentation on referrals to promote Team awareness and ensure patient safety. This tracking may use an IT database.
- Ensure complete and accurate registration, including patient demographic and current insurance information.
- Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
- Contact review organizations and insurance companies to ensure prior approval requirements are met.
- Present necessary medical information such as history, diagnosis and prognosis.
- Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians.
- Review details and expectations about the referral with patients.
- Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
- Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns.
- May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
- Identify and utilize cultural and community resources.
- Establish and maintain relationships with identified service providers.
- Ensure that referrals are addressed in a timely manner. Remind patients of scheduled appointments via mail or phone.
- Ensure that patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organizations related to their health.
- Understands and follows the Code of Conduct and HIPPA guidelines
Skills and Specifications
- High school diploma, sometimes combined with medical assistant certification
- Strong customer service focus
- Effective verbal and written communication skills
- Teamwork orientation
- Organized and able to manage competing priorities
- Good judgment
- Resourcefulness in problem solving
- Able to take and follow through with delegated tasks and accountability
- Bilingual skills preferred (English/Spanish
Innovacare participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.
Skills Required
- High school diploma
- Medical assistant certification
- Strong customer service skills
- Effective verbal and written communication skills
- Teamwork orientation
- Organization and ability to manage competing priorities
- Good judgment
- Resourcefulness in problem solving
- Ability to follow delegated tasks through to completion and maintain accountability
- Bilingual English and Spanish skills
What We Do
InnovaCare Health improves the lives of members and physicians through innovative solutions for value-based healthcare. In each unique market the company serves, InnovaCare works across the healthcare ecosystem – with patients, providers, payers and other partners – to increase access to high-quality, affordable care. Based in White Plains, N.Y., InnovaCare has been on the forefront of value-based care for more than a decade, distributing risk and developing proprietary technologies to inspire patient and provider engagement. Through an integrated portfolio of health plans, medical service organizations, clinical networks and more, the company manages more than 500,000 lives, including more than 150,000 dual-eligible beneficiaries. InnovaCare’s Medicare Advantage plans have received NCQA accreditation and 4.5-star quality ratings from the Centers for Medicare and Medicaid Services (CMS).
