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Referral Coordinator

Nursing
Status: 
Full Time
Department: 
Nursing
Location: 
Warren
Hours: 
8am-5pm
Union: 
Non-Union
Grant or HJAHC: 
HJAHC
Description: 

MAJOR FUNCTION:
Under the supervision of the Supervisor of Nursing, the Referral Coordinator will oversee the referrals to ensure referrals are completed in a timely manner.  The Referral Coordinator will assist with the completion of in-house referrals and preauthorization as well as assist Unit Receptionists who are assigned to providers to complete referrals. They will provide support for HJAHC clinical staff and increase efficiency for the patients and the community.  
ESSENTIAL FUNCTIONS:

  • Monitor and maintain tracking and appropriate documentation on referrals and patient authorizations to promote team awareness and ensure patient safety.  This tracking will be used to inform supervisors of any expired dates.
  • Ensure complete and accurate registration, including patient demographic and current insurance information.
  • Assemble information concerning patients’ clinical background and referral needs.  Per referral guidelines, provide appropriate clinical information to specialist.

 

  • Contact review organizations and insurance companies to ensure prior approval/ preauthorization’s requirements are met.  Present necessary medical information such as history, diagnosis and prognosis.  Provide specific medical information to the hospital and physicians.
  • Review details and expectations about the referral with patients.
  • Communicate and follow up with insurance companies to ensure all documentation proving medical necessity has been received for efficient processing.
  • Communicate with patients and referring providers to ensure follow-through with referrals.
  • Support doctors, staff and patients in documenting insurance requirements.
  • Educate and train staff on proper referral documentation and completion.

 

  • Assist patients in problem solving potential issues related to the health care system, financial or social barriers (ex. 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.
  • Ensure that referrals are addressed in a timely manner.
  • Remind patients of schedule appointments via mail, phone, email, etc.
  • Ensure that patient’s primary care chart and documentation is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.
  • Follow up on patients for no show referred to specialty practice.
  • Foster Joy in the Workplace in accordance with organizational initiatives
  • All other related job duties

Professional Requirements

  • Meets dress code standards; appearance in neat and clean.
  • Completes annual educational requirement.
  • Maintains regulatory requirements.
  • Reports to work on time and as scheduled; completes work within designated time.
  • Wears identification while on duty; uses computerized punch time system correctly.
  • Maintains patient confidentiality at all times.
  • Completes in-services survey’s and returns in a timely fashion.
  • Attends annual review and department in-services, as scheduled.
  • Attends a minimum of 10 staff meetings annually; reads monthly staff meeting minutes.
  • Represents the organization in a positive and professional manner.
  • Actively participates in performance improvement and continuous quality improvement (CQI) activities.
  • Complies with all organizational policies regarding ethical business practices.
  • Communicates the mission, visions and goals of the facility, as well as the focus statement of the department.

 
 
PREREQUISITES FOR THE JOB:
EDUCATION/ EXPERIENCE:

  • High School Diploma or GED

PERSONAL CHARACTERISTICS

  • Strong customer service skills
  • Teamwork orientation
  • Organized and able to manage competing priorities
  • Good Judgement and resourcefulness in problem solving
  • Excellent written and verbal communication skills
  • Respectful to staff across all levels of the organization, patients and their families, and outside personnel