Shared Market Clinical - Referral Coordinator

ArchWell Health; Tucson (AZ); On-site; USD 42,000 - 62,000; Full time

Job summary

ArchWell Health is seeking a Referral Coordinator to help members navigate the complex healthcare system, coordinating internal and external referrals to ensure seniors receive the right care at the right time.

The ideal candidate will have strong attention to detail, experience in care coordination, HIPAA compliance, and the ability to communicate effectively with diverse populations, including Spanish-speaking members.

Qualifications

• H.S. Diploma or equivalent required; healthcare coursework preferred.
• 2 years of experience in referral management or care coordination.
• Experience with EMR systems (eClinicalWorks preferred).
• Bilingual in Spanish helpful.

Responsibilities

• Coordinate referrals to external providers to ensure timely care.
• Complete documentation for member referrals.
• Maintain HIPAA compliance and protect PHI.
• Build relationships with members and families to facilitate care.
• Act as system navigator and point of contact for questions.

Skills

Healthcare navigation

Benefits verification

HIPAA compliance

CPT codes

ICD-10 codes

Interdisciplinary teamwork

Communication skills

Multitasking

Microsoft Office

Spanish language

Education

H.S. Diploma or equivalent

Medical Assistant experience helpful

Tools

eClinicalWorks EMR

Job description

ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities.

Job Summary:

The Referral Coordinator is responsible for supporting our members as they navigate the complex healthcare delivery system, ensuring every member receives the right care in the right setting. This individual will serve as a guide for the member and their families to ensure the member meets with the right specialists, inside or outside the center, in a timely manner. An ideal candidate will have a deep understanding of the healthcare ecosystem, have strong attention to detail, and be driven by a passion for providing quality care to seniors.

Duties/Responsibilities:

• Partner with ArchWell Health's multi-disciplinary care team to gain a deep understanding of each member's care needs, including identifying gaps and barriers to treatment
• Coordinate referrals to external providers, vendors, and services to ensure care needs are met
• Complete proper documentation for member referrals to ensure records are accurate and current
• Build and nurture relationships with members and their families to successfully facilitate care coordination
• Carry out all activities and provide ongoing monitoring as outlined in a member's care plan to ensure routine follow up and progression is made on care plan goals
• Adhere to HIPAA standards and confidentiality of protected health information (PHI)
• Promote clear communication among care team and treating clinicians to ensure positive member outcomes
• Assist members 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 members and families, with patients and families having direct access for asking questions and raising concerns.
• Additional duties, as assigned

Required Skills/Abilities:

• Deep understanding of the healthcare ecosystem, ideally with experience in benefits and insurance authorization
• Passion for helping senior members successfully carry out care plans
• Ability to work effectively with diverse populations including staff, providers, members, family members, insurance carriers, vendors, and the public
• Basic medical terminology
• Understanding of Medicare criteria for equipment and supplies
• Knowledge of CPT and ICD-10 codes
• Working knowledge of specialists and community resources to assist the member
• Strong communication and rapport-building ability among an interdisciplinary team
• Ability to multi-task and manage competing priorities with high attention to detail
• Proficient PC skills to include Microsoft Office
• Fluency in Spanish, or languages spoken by the people in the communities we serve (where necessary)

Education and Experience:

• H.S. Diploma or equivalent required; degree or college level coursework in healthcare preferred
• 2 years of experience in referral management or care coordination
• Medical Assistant or medical administrative experience is helpful
• Experience with EMR systems, ideally eClinicalWorks or similar

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.