Reporting to the Manager of Population Health the Referral Coordinator/or designee is responsible for patient healthcare outcomes to improve health and meet or exceed value based reimbursement payments. The Referral Coordinator will track assigned internal and external referrals for completion. This role serves as a primary interface between Total Health Care (THC) and internal and external healthcare organizations to assist with assuring referrals are completed and received. This position also serves as a patient navigator for gaps in care, loss to care, new to care and management of chronic care patients.

Contacts and interactions vary and may involve multiple constituencies such as direct interaction with THC’s executive management, community organizers, the general public, THC’s patients, physicians, colleagues, assigned staff, vendors, contractors and consultants for the purpose of providing and exchanging information.

Example of Essential Job Functions

Tracks and reviews internal and external referrals daily for referral completion.

• Review referrals for additional follow-up if needed.
• Forward referrals to internal and external providers and healthcare facilities.
• Obtain and electronically fax completed referrals into the Electronic Health Record (EHR).
• Document all actions and communication in electronic medical record in real time.
• Contact patients with pending referrals and provide education on the importance of completion of referral.
• Identify and assist with any barriers for referral completion and refer to Community Health Workers (CHW’s) and/or Care Manager/Coordinator.
• Process incoming and outgoing calls to assist with pending referrals.
• Providing appropriate clinical information to requesting referred provider.
• Contact providers via EHR with authorization, denial and appeals process information as necessary.
• Assist patients with making referral appointments as needed.
• Review Managed Care Organizations gaps in care, loss to care and newly assigned patients list.

• Other duties assigned.

Minimum Education, Training and Experience Required

• Minimum 3-5 years clinical experience in any of these areas: acute care, home health, physician office management, managed care organization,
• Experience with Microsoft Office.
• Experience with Referral process and Insurance Authorizations preferred
• Experience with EHR programs preferred
• Must have excellent customer skills.