Referral Coordinator

Summary

Under the direction of the Network Operations team, the Coordinator provides support to the network operations team, providers, and members. The Coordinator facilitates referral management working with providers, patients, and the health plans to share essential patient information and assist primarily in scheduling appointments and coordinating care. Participates in various outreach campaigns and facilitates processes that promote successful care transitions.

Location

Houston area preferred; remote WFH/hybrid office setting

Essential Functions include the following. Other duties may be assigned.

• Maintains ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety
• Assembles information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
• Contacts review organizations and insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis and prognosis. Provides specific medical information to financial services to maximize reimbursement to the hospital and physicians
• Sets appointments and processes transfers to ensure timely transmission and start of services.
• Assists patients in problem solving potential issues related to the health care system, financial or social barriers. Acts as a liaison for patient resources
• Ensures that the patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.
• Performs administrative tasks to make recommendations to people in need of services, as well as relaying important information to companies and organizations
• Participates in various telephonic outreach campaigns, engaging members in wellness, prevention and care coordination efforts