Referral Coordinator - PRMC

0090 Presbyterian System Services; United States; On-site; USD 23,000 - 38,000; Full time

Benefits offered by this job

Comprehensive benefits package

Wellness rewards program

Job summary

Presbyterian Healthcare Services is hiring a Referral Coordinator at Plains Regional Medical Center to manage referrals and prior authorizations with providers. The role requires strong communication and organizational skills and a patient-focused approach to scheduling and service delivery.

You will interact with referring offices, coordinate scheduling for specialties and radiology, and ensure accurate hand-offs and timely updates within the EHR system.

Qualifications

• High school diploma or equivalent required.
• Minimum 18 months medical office experience with MD interaction.
• Proficient in prior authorization/certification/referral processes.
• Must pass EPIC registration competency after training.
• Short-term training in Medical Terminology.
• Working knowledge of CPT and ICD-10 coding.
• Pass annual competency exam for responsibilities.
• Strong organizational and multitasking abilities.
• Excellent customer service skills; remain professional under pressure.

Responsibilities

• Coordinate referrals from providers and offices; use CARES, AIDET, and EPE tools.
• Ensure timely communications with providers and patients.
• Schedule referrals, answer questions, and arrange provider communications.
• Resolve concerns, escalating as needed to find solutions.
• Coordinate access for referrals across program departments.
• Follow up to confirm referral status and next steps.
• Guide referring offices on prior authorization requirements.
• Prepare and hand off referrals with appropriate documentation.
• Enter all faxed referrals into the EHR system.

Skills

Communication

Organization

Customer service

Prior authorization

Multitasking

Education

High school or equivalent

Tools

Epic Clerical Training

EPIC

CPT/ICD-10 coding

Job description

Location Address: 2100 N Dr Martin Luther King Jr Blvd Clovis, NM 88101-9412

Compensation Pay Range: Minimum Offer $16.79 Maximum Offer $27.67

Now Hiring: Referral Coordinator - PRMC

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, etc

Type of Opportunity: Full time

Job Exempt: No

Job is based: Plains Regional Medical Center

Work Shift: Days (United States of America)

Responsibilities:

• 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 effective to ordering clinician when any restriction, such as access, restricts or prohibits scheduling as ordered

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 Here, we’re committed to a different way to make a difference. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, nurses, employees, board members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than one in three New Mexicans. We are part of New Mexico's history and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.