Referral Coordinator - PRMC

Presbyterian Healthcare Services; Elk City (OK); On-site; USD 23,000 - 38,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Short-term disability

Long-term disability

Life insurance

Other voluntary benefits

Job summary

Presbyterian Healthcare Services is seeking a Referral Coordinator at Plains Regional Medical Center to manage referral requests from referring providers, coordinate with departments, and enter referrals into the EHR. The role emphasizes strong scheduling knowledge, authorization processes, and patient/provider communication.

The position requires high school education, 18 months in a medical office, EPIC competency, and knowledge of CPT/ICD-10 coding, with a focus on delivering patient-centered

Qualifications

• High school or equivalent; 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

• Achieve exceptional provider and referring office experience using CARES, AIDET and EPE tools.
• Ensure all communications with providers and patients are timely.
• Schedule referrals and arrange provider-to-provider communication as needed.
• Resolve concerns and requests using resources and escalation when necessary.
• Coordinate with departments to gain access for referrals.
• Follow up with referring providers on referral status.
• Maintain knowledge of program operations to guide referrals and hand-offs.
• Coordinate with Business Development to collect feedback for exceptional experience.
• Manage incoming referrals from receipt to completion.
• Enter faxed referrals into the EHR.
• Guide referrals through prior authorization requirements.
• Prepare and hand off referrals based on scheduling workflows.
• Ensure necessary medical records and testing orders are in place.

Skills

Prior Authorization

EPIC Competency

Medical Terminology

Customer Service

Organization & Multitasking

Education

High school or equivalent

Tools

EPIC EHR

Job description

Referral Coordinator - PRMC

Location Address

2100 N Dr Martin Luther King Jr BlvdClovis, NM 88101-9412

Compensation Pay Range

Minimum Offer $16.79 Maximum Offer $27.67

Summary

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, etcType of Opportunity: Full timeJob Exempt: NoJob is based: Plains Regional Medical CenterWork Shift: Days (United States of America)

Responsibilities

• Customer Service and Caring Practices: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.
• Medical Record Components:
• Instructs patients on the Release of Information process and insure a fully completed ROI Form is submitted to Health Information Management for incoming or outgoing records
• Patient Relations:
• Comprehend quality service connection to patient satisfaction and reimbursement
• Participate in metric goals for telephones performance metrics, TSF and abandonment rate when applicable
• Perform confirmation calls when applicable to include directions and instructions as required by the visit type
• Patient Safety:
• Respond quickly to patients showing distress. Follow guidelines set forth by the Clinic Manger to alert the clinical team. Assist in any manner the clinic team directs.
• Ensure check out area, waiting area and walkways are clear of any unnecessary items and are clean and neat.
• Report any concern that may create a safety issue.
• Annual competency completion of Clerical Staff during a Code Blue
• Quality Improvement:
• Appointment reminder calls
• Rescheduling
• Evaluate provider schedules and take appropriate action to ensure accuracy and efficiency per guidelines
• Works with assigned physicians to maximize schedule effectiveness
• C.A.R.E.S Behaviors:
• Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter

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