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Bilingual Referral Coordinator
Remote
Our mission is to make healthcare right. Together. We are a value-driven healthcare company committed to providing personalized care to aging and underserved populations. We do this by aligning stakeholders across the healthcare ecosystem. Together, we can improve consumer experience, optimize clinical outcomes, and reduce total cost of care.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives apply to join our team.
SCOPE OF ROLE
The role of the Referral Coordinator is to facilitate consistency of information shared across practices to promote care coordination and effective member co-management for behavioral and non-behavioral practitioners. The Referral Coordinator collaborates with clinical team members to evaluate the potential over and under-utilization of specialty services based on clinical protocols.
ROLE RESPONSIBILITIES
- Prioritizes assigned patient cohorts to ensure specialty referral completion and ensures stat and expedited referrals are completed based on timeliness standards
- Schedules patients (Preferred Providers List of Specialists) and notifies them of appointment information, including, date, time, location, etc.
- Ensures missed specialty appointments are rescheduled and communicated to the physician/clinician.
- Ensures specialist notifications of referral status
- Completes exchange of information by retrieving and ensuring upload of specialty consultation and follow-up notes
- Completes documentation based on standardized documentation; to include, but not limited to location, notification of specialist, notification of patient, status of appropriateness reviews
- Enters all Inpatient and Outpatient elective procedures in EMR and contacts specialist for post-procedure referral needs
- Follows up on all Home Health and DME orders to ensure the patient receives the services ordered.
- Completes appropriateness review based on clinical protocols and appropriately refers to Nurse or Medical Director
- Addresses referral based phone calls for Primary Care Physicians panel and completed phone messages timely
- Facilitates escalation of denied referrals to the clinical team for appeal reviews.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- High School Diploma
- Minimum 2 years of experience in medical management.
- Capacity to interpret health plan benefit decisions
LICENSURES AND CERTIFICATIONS
- Certification as a Medical Assistant preferred
WORK ENVIRONMENT
- The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
- Some travel may be required.
As an Equal Opportunity Employer, we welcome and employ a erse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.