Referrals Coordinator

WHO WE ARE:

Aviva Health is a dynamic and mission-driven federally qualified health center (FQHC). Committed to providing comprehensive and compassionate healthcare services, Aviva Health offers a holistic approach to care, addressing patients' medical, behavioral health, dental, and social service needs. As a vital healthcare resource in the community, Aviva Health fosters a collaborative and supportive work environment where dedicated healthcare professionals have the opportunity to make a meaningful impact on the lives of individuals and families.

Join us at Aviva Health and be part of a team that is dedicated to making a difference in the lives of our patients and the community we serve.

• Monday - Friday Scheduling
• Paid Holidays
• PTO
• Comprehensive Medical, Dental, and Vision Coverage
• 403(b) Retirement with Employer Match

Under the supervision of the Referrals and Medical Records Supervisor, the Referrals Coordinator utilizes established procedures to assist providers in referring patients to specialists outside of the clinic as appropriate. Ensures efficient and effective flow of internal and external referrals, insurance authorizations for internal and external procedures, and medication pre-authorizations during scheduled clinic hours through joint planning and problem solving with clinic staff.

Ability to keep several tasks moving along in a well-organized, compassionate, and professional manner while functioning at a high level of accuracy is critical.

• Works out of the electronic medical record (EMR) for referral orders and determine where to refer if the provider has not indicated a specific specialist.
• Continuously monitors chart notes and reminds providers of the need for chart notes to be completed after seventy-two (72) hours to process referrals.
• Communicates and coordinates with specialists to facilitate scheduling as needed, complete facility referral forms, and fax all pertinent information. Obtain status of appointment, completion of visit, and request office notes to complete the referral process to remain PCPCH compliant.
• Communicates with patients any information required for referral appointments as needed. This may include date and time of appointments, location of the specialist, explanation of the process, and expected notification time, insurance status, and changes.
• Maintains and processes Veteran Community Care Authorizations for internal and external referrals.
• Processes medication prior-authorizations and follows up daily on pending cases. Notifies pharmacies of medication approvals. Communicates with pharmacies to obtain prescription insurance information as needed. Notifies providers of denials and provides guidance regarding insurance guidelines for coverage.
• Prioritizes incoming authorization requests according to urgency.
• Appropriately forwards all referral service requests to the next level of clinical review as applicable and after verifying for completeness and appropriateness. Communicates with referring practice if information is incomplete, inaccurate, or additional information is needed. Provides updates to the referring practice in each phase of the referral process.
• Reviews chart documentation to ensure patients meet medical policy guidelines.
• Research member history for duplications and considerations of authorization limits.
• Reviews and processes insurance authorizations for internal procedures, imaging, and external facilities as requested. Notifies internal or external facilities when the prior authorization is approved. Reviews denied Prior Authorization requests and provides guidance regarding supporting documentation that may be required for approval and notifies the provider.
• Answers the telephone promptly and in a polite and professional manner and makes direct calls to other departments accordingly.
• Promotes a strong belief in Aviva Health’s philosophy, purpose, mission, and ideals.
• Demonstrates Aviva Health’s values and approaches all tasks with Aviva Health’s Mission, Vision, Values, and Customer Service statements as guidelines. Demonstrates care and compassion, respect, sharing, professionalism,…