Referral Coordinator

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: Part Time (.45 to .89)
FTE: 0.500000
Exempt: No
Work Schedule: Days

Other information:
*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

Education:
Essential:
* High School Diploma or GED

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

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

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. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a 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 1,600 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.

About Our Regional Delivery System

Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

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.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

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