Referral Coordinator

Presbyterian Healthcare Services; Rio Rancho (NM); On-site; USD 23,000 - 38,000; Full time

Job summary

Presbyterian Healthcare Services in Rio Rancho, NM seeks a Referral Coordinator to manage referrals, authorizations, and scheduling for outpatient services. You will work with referring providers, navigate prior authorization requirements, and ensure timely, accurate communications.

The role emphasizes collaboration across departments and adherence to Epic workflows. Ideal candidates will have a high school diploma and 18+ months in a medical office setting, with strong organizational skills and

Qualifications

• High school or equivalent; Minimum 18 months experience in a medical office setting with significant MD interaction.
• Proficiency in prior authorization/certification/referral process.
• Must pass EPIC competency for Registration at completion of Epic Clerical Training class; Short-term training in Medical Terminology; Working knowledge of CPT and ICD-10 coding.
• Pass annual competency exam for all areas of responsibility.
• Requires strong organizational and multi-tasking skill sets; Significant customer service skill set.
• Must be able to function under pressure while maintaining professionalism

Responsibilities

• Navigate complex provider requests and coordinate referrals via phone and EHR.
• Develop and maintain positive working relationships with referring offices and providers.
• Ensure prior authorization, certification, and referrals are obtained for visits and procedures.
• Scrub schedules for accuracy, monitor in-baskets, and track overdue results and recalls.
• Communicate timely status of referrals and provide provider-to-provider hand-offs as needed.
• Assist with scheduling, access coordination, and referral communications across departments.

Skills

Customer service

Communication

Organizational skills

Multi-tasking

EPIC proficiency

Education

High school diploma or equivalent

Tools

EPIC

Job description

Location Address:

2400 Unser BlvdRio Rancho, NM 87124

Compensation Pay Range:

Minimum Offer $16.79Maximum Offer $27.67Now Hiring: Referral Coordinator

Summary:

Build your Career. Make a Difference. Presbyterian is hiring a skilled Referral CoordinatorType of Opportunity: Full timeJob Exempt: NoJob is based: Presbyterian Rust Medical CenterWork Shift: Weekday Schedule Monday-Friday (United States of America)

Responsibilities:

Navigate complex requests from referring providers and their offices, primarily via phone. Develop and maintain positive working relationships with providers and referring offices. Address requests and concerns using knowledge of organization and ability to identify resources; Use high level of diplomatic skill to handle all calls in positive and professional manner. Advanced scheduling for specialty or radiologic procedures; Recognize payor requirements and obtaining prior authorization/certification/referrals for visits/procedures; Return scheduling knowledge to include the ability to scrub schedules for accuracy and efficiency in home department; Monitor in-baskets and reports for overdue results, waitlisted appointments, recalls, etc

• Achieve exceptional experience for providers and referring providers offices by using CARES, AIDET and EPE tools.
• Ensures all communications with providers and patients occurs in a timely manner
• Communicates with referring providers and their offices to schedule referrals, answer questions, and arrange provider-to-provider communication as needed
• Addresses and attempts to appropriately resolve concerns and requests in the moment by using resources and appropriate escalations to find solutions
• Coordinates with departments throughout program to gain access for referrals
• Follows up with referring providers to ensure they know the status of their referral or request
• Maintains strong knowledge of program operations and processes in order to guide referring providers and answer questions about potential referrals and perform appropriate hand-offs
• Coordinates with Business Development partner to collect feedback from referring offices in order to ensure an exceptional experience.
• Encounter Components:
• Ability to manage conflict and appropriately request the help of a supervisor when needed
• Fosters effective patient relations with patients, the public and providers by listening, responding and escalating when appropriate
• Works with program providers, testing departments, and health plan representatives to facilitate creating access for referrals and members as needed
• Facilitates provider-to-provider communication as requested Encounter Components
• Coordinates incoming referrals from the time they re received to completed
• Enters all faxed referrals into EHR
• Guides and assists referring offices through Prior Authorization request requirements and processes
• Understands surgical and procedural scheduling workflows in order to appropriately prepare and hand-off referrals
• Ensures relevant medical records are requested
• Ensures any testing required for referral is ordered and scheduled
• Communicates effectively to ordering clinician when any restriction, such as access, restricts or prohibits scheduling as ordered
• Supports program providers with scheduling, access coordination, and referral communication needs
• Refers as appropriate to on site Financial Advocate, or for uninsured to the Financial Advocacy Center
• Validate prior authorization/certification/referral are secured PRIOR to a scheduled procedure or test, alerting stake holders (patient, patient representative, OR, etc) if a breakdown occurs Message Management
• Message Management:
• Answers all incoming provider calls; including from outpatient referring offices, inpatient requests for consults, and internal program providers
• Follows established workflows for paging the appropriate program providers regarding consult requests
• Formulates complete and accurate telephone encounter messages and routes to the appropriate Epic in-basket pool to support operational aspects of patient care.

Qualifications:

• High school or equivalent; Minimum 18 months experience in a medical office setting with significant MD interaction;
• Proficiency in prior authorization/certification/referral process;
• Must pass EPIC competency for Registration at completion of Epic Clerical Training class; Short-term training in Medical Terminology; Working knowledge of CPT and ICD-10 coding;
• Pass annual competency exam for all areas of responsibility;
• Requires strong organizational and multi-tasking skill sets; Significant customer service skill set;
• Must be able to function under pressure while maintaining professionalism

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness

Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services