University of Rochester Referral Coordinator in Rochester, New York
Full Time 40 hours Grade 009 Ophthalmology
8 AM-6 PM
Under the primary supervision of the Specialist Department but with significant latitude for independent decisionmaking serves as the patient referral coordinator, with oversight of data and compliance to enterprise standards and referral guidelines. Conducts data analyses to track patient compliance with specialty services. Communicates regularly with patients, families, clinical and non-clinical staff, identifying barriers to appointment compliance, and tracking all assistance provided. Responsible for managing department referrals; consistently monitoring the Epic work queues; communicating with referring and referred to departments to reconcile any discrepancies and/or answer any questions. Approved protocols for working referrals will be adhered to.
With significant independence and latitude for action serves as liaison, appointment coordinator, and patient advocate between the referring office, specialists and patient to assist in the coordination of scheduled visits incorporating all incoming referrals to the department using Epic Referral work queues.
- Perform a needs assessment using information from the electronic medical record to assure the appropriate appointment/procedure is schedule with the appropriate provider; ensuring that accurate patient demographic and current insurance information is captured; Adheres to RIM protocols for record verification
- Provides regular data to team on patient compliance with treatment plans and strategies to improve patient compliance which includes provider template oversight, reporting to manager any obstacles to timely scheduling
- Escalates case management when medical assessment is needed
- Ensures ancillary testing and other specialty referrals have been executed and results received and acted upon as needed. Investigates failure to receive such information, troubleshoots, resolves, and/or makes recommendations to insure delivery/receipt.
- Requests and coordinates team and patient meetings as needed or requested by patient. Participates as an active member of the care team.
- Acquire insurance authorization for the visit and, if applicable, any testing; insurance authorization information will be entered in the Epic referral record for the patient, and attaches referral records to any visits in which they are missing
- Provides patients with appointment and provider information, directions to the office location and any educational materials if appropriate
- Prioritize referral requests using medical protocols, responding immediately and expediting most urgent requests
- Documents all communications pertaining to the referral and/or insurance authorization in the notes section of the Epic referral record
- May perform complex appointment scheduling, linking referrals and ancillary services for the assigned specialty service
- Ability to make decisions that are guided by protocols and practices requiring some interpretation; maintains an expert level understanding of the department/division
- Prior authorization functionality will be required for testing and services ordered by referred to specialist including but not limited to:
- Prepares and provides multiple, complex details and facts to insurance carrier or worker's compensation carrier to obtain prior authorizations for both standard and complex requests such as imaging, non-invasive procedures, sleep studies etc.
- Communication of medical information to the insurance carrier
- Coordination of peer-to-peer reviews for denied services
Manages orders for patients being seen in ED/ Urgent Care
- Demonstrates expert medical knowledge base with ability to recognize urgent clinical situations
- Prioritize referral requests, responding immediately and expediting most urgent requests
- Reviews complex referral requests, evaluates and schedules to the appropriate provider
- Works with providers and other clinical staff to establish the best care plan for the patient
Processing of the outgoing referrals.
- Discuss with patient options for outside URMC options for care
- Assures Meaningful Use requirements are met
- Ensure that the Summary of Care was transferred electronically via Epic to the referred to office; if the Summary of Care was not or cannot be transferred via Epic, additional steps will be taken to get this information to the referred to office either via facsimile or mail
Process incoming referrals not generated within the UR system
- Completes referral entry for all external referrals into Epic following approved protocols
- Coordinates any ancillary testing and obtains any outside records needed for patient appointment
- Monitors referral indicators dashboard and reporting to ensure compliance with enterprise guidelines and meaningful use
- Primary contact for insurance companies incentive programs, tracks and reports data to department and Patient Access team
- Conducts data analyses and makes recommendations for improvements at team conferences. Provides regular care team updates on weekly/monthly basis as needed.
- Participates in patient referral team conferences to develop referral management strategies for barriers to care. Has an active role in enterprise referral committees, providing regular updates at department staff meetings. Educate office staff on patient or office system issues, patient communicated inconsistencies between the PCP and referring specialists.
- Perform advance Referral Coordinator Functions and serves as a resource for other department and divisional staff
- Identifies and reports problems and inefficiencies in existing system and recommends changes when
- Maintain ongoing appropriate documentation on all referral records within Epic to promote team awareness and ensure patient safety
- Utilizes insurance web portals as necessary for insurance authorization and approval information
- Researches and resolves problems with patients accounts as identified in the work queues
- Assist patients with problem solving potential issues related to financial (providing information on the Financial Assistance Program and Cost Estimator Hotline) or social (providing interpreter services) barriers
- Minimum 2 years collegiate education and 2 years related work experience; or an equivalent combination of education and experience.
- Proficiency with Epic.
- Front Desk
- Referral Coordinator
- Prefer medical terminology experience and familiarity with ICD 10 and CPT information.
- Maintains familiarity with various insurance products and their referral/authorization guidelines
- Excellent verbal and written communication skills
- Strong problem solving and complex patient management skills
- Demonstrated ability to process data entry with a high level of accuracy.
- Commitment to the organization to do what is necessary to have a successful Referral Coordinator program
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: Referral Coordinator
Location: Medical Faculty Group
Job ID: 209734
Full/Part Time: Full-Time