Diagnostic Referral Coordinator

Responsible to coordinate and complete specialty and diagnostic services in a timely and efficient manner for Grace Health patients; and obtain prior authorizations when indicated.

JOB SPECIFIC DUTIES:

• Coordinate all aspects of a specialty and/or diagnostic referral in a timely manner when requested by Grace Health providers.
• Check the diagnosis code on the orders to make sure they meet insurance guidelines and are medically necessary.
• Call and schedule patient’s test and inform the patient on when and where to go.
• Verify insurance coverage and obtain prior authorizations for services to be rendered as required by individual insurance plans.
• Ensure that the specialist accepts the patient’s insurance plan.
• Assemble referral paperwork and requested medical information and submit to the specialty office as needed.
• Communicate referral information to the patient and providers.
• Document appointment or preauthorization information in Nextgen EMR or in an electronic log of all referrals.
• Provide excellent customer service to both internal and external customers.
• Establish and maintain professional relationships with all staff.
• Inform leadership of authorization or referral concerns, back logs, or insurance issues.

• Follows policies and procedures of the office, including administrative, clinical, quality assurance, and personnel
• Maintain good attendance (daily, meetings, and other assignment tasks)
• Maintain timely documentation of all work assignments
• Maintain patient confidentiality
• Routinely keep supervisor informed about attendance and job assignments
• Flexible in being able to multitask
• Work effectively and at an efficient pace
• Work cooperatively with physicians, administration, and peers

• Grace Health recognizes that managing patient care is a team effort involving both clinical and non-clinical staff. All employees must embrace a team-based approach to patient care and understand that each role is important to our success.
• Team members must demonstrate excellent communication and coordination skills to provide quality patient care.
• Care coordination includes communication with community organizations, health plans, facilities, and specialists.
• Care team members must understand and embrace the concept of population health management and proactively address the needs of patients and families served by the practice.
• Team members must demonstrate the skills and knowledge necessary to communicate effectively with vulnerable patient populations.
• Team members must participate in Continuous Quality Improvement (CQI) activities within the organization to ensure patients receive high-quality care.
• All team members will be involved in improving quality outcomes.
• Team members will participate in the review and evaluation of practice performance and help identify opportunities for improvement.
• Team members will participate in Grace Health's advocacy program.

• Follows all organizational policies and procedures, including administrative, clinical, quality assurance, and personnel policies.
• Maintains satisfactory attendance, including attendance at meetings and completion of assigned tasks.
• Maintains timely documentation of all work assignments.
• Maintains patient confidentiality.
• Routinely keeps the supervisor informed regarding attendance and job assignments.
• Demonstrates flexibility and the ability to multitask.
• Works effectively and efficiently.
• Works cooperatively with providers, administration, and peers.

To perform this job successfully, an individual must be able to support and advance Grace Health's mission while satisfactorily performing each essential duty. The requirements listed…