Referrals Coordinator - SOS International LLC

*** This position is contingent upon contract award ***

SOSi is seeking a Referrals Coordinator (RC) to process government customer medical referrals for off-site medical appointments to work on-site in Elizabeth, NJ.

The Referral Coordinator is the primary point of contact (POC) and liaison between the government customer Health Plan Management Unit, requesting provider, and the community provider to initiate enrollment as well as assist with billing and claims resolution as applicable.   

• Prepares, updates, and maintains medical referral information for each patient ensuring accuracy of information in the patient’s medical record.
• Supports the outside provider recruitment process as liaison between providers and government customer.
• Maintains a system of records for tracking purposes for reference in support of the Provider Network.
• Coordinates the purchase or rental of durable medical equipment for detainees in custody.
• Contacts the off-site community medical providers to schedule appointments for specialty care based on the provider referral and documents specific appointment date in the eHR.
• Tracks compliance with scheduled patient appointments, making timely reminder notices, or calls to the off-site facility (hospitals, long-term care facilities, etc) and government customer staff prior to each appointment where applicable.
• Coordinates transportation with custody transport staff for the scheduled off-site medical appointments and creates the sealed medical packet that is sent with the patient, via custody transportation staff, that contains pertinent medical documentation for the appointment.
• Files/scans laboratory, radiology, and other reports in appropriate sections of the electronic medical record when patient returns from off-site visit.
• Routes clinical reports to appropriate clinic staff within prescribed timeline.
• Corresponds with off-site medical facilities and Provider network providers to request pertinent medical information to place in the medical record using appropriate and forms.
• Tracks requests and performs follow-up ensuring receipt of information requested.
• Handles all correspondence requiring authorizations for payment of medical services.
• Reviews all documentation for completeness and routes incomplete documents to the appropriate provider for correction prior to placing/scanning in the medical records.
• Receives and processes requests for information in accordance with the Fair Information Practice Principles and Privacy Act.
• Uses multiple systems to process a variety of narrative and tabular material (e.g., eHR systems, email correspondence, eXCEL tabular data, Enterprise Business Optimizer reports, etc.) to prepare, update, and maintain a medical record and provide required and requested information to appropriate medical personnel.
• Completes reports needed to ensure that all referrals have been completed correctly before they are transmitted to the VA system for payment and corrects any errors found.
• Assists to reconcile and resolve denied outside provider claims.
• Performs record keeping functions in accordance with program policies and position.
• Maintains functional proficiency and ease of use utilizing electronic health records and referrals.
• Completes and passes all Referrals Coordinator competencies, initially and annually.
• Completes all initial, annual and ad hoc training as required/assigned.
• Serves as a team member for analyzing established protocol practices and identifying areas for improvement.
• Maintains patient confidentiality, and confidentiality of medical records, in compliance with the Privacy Act and HIPAA regulations in all work activities.
• Adheres to and maintains awareness of: Policies, Procedures, Directives, Operational Memoranda and accreditation standards as prescribed by customer.
• Adheres to and participates in: Safety, Quality Improvement and other programs and collateral duties as appropriate to position.
• Attends and participates in general/medical staff meetings.

• High School Diploma or GED equivalent.
• Minimum of one-year experience in a healthcare setting as a medical record technician, medical record clerk, unit secretary, or similar position where the processing of electronic medical/health records was part of the daily responsibilities.
• Ability to obtain/maintain required security clearance.
• Ability to obtain/maintain pre-employment medical clearance.
• Knowledge of the basic principles and standards of eHR procedures and methods.
• Knowledge of the documentation requirements, timeliness of referral management, and knowledge of eHR workflow to process electronic medical referrals and records, to review referrals and records for accuracy and completeness, and to keep track of processing deadlines.
• Basic fluency of medical terminology.
• Administratively processes medical referrals for off-site medical appointments.
• Schedules off-site specialty consults and follow-up appointments. Requests and uploads medical records to the electronic Health Record (eHR).
• Recognize documentation inconsistencies in referrals within the eHR ensuring compliance and resolution.
• Knowledge of Current Procedural Terminology (CPT) codes.
• Ability to work in a multi-cultural environment.
• Ability to work approximately 90% of time using a computer, telephone, scanner, and printers.
• Ability to utilize telephonic interpreter/translation services to complete assigned duties if not fluent in a language the patient understands.
• Ability to adapt to sudden changes in schedules and flexibility in work requirements.
• Ability to communicate proficiently in English (verbal and written) in order to develop positive rapport with patients, co-workers and other stakeholders.
• Ability to establish and maintain positive working relationships in a multidisciplinary environment.
• Ability to navigate in an electronic work environment including eHR, web-based trainings and Microsoft Teams application navigation.
• Knowledge of and functional proficiency in common Microsoft Office programs, specifically Microsoft Word, Excel, Outlook and SharePoint.
• Knowledge of regulations (HIPAA/Privacy Act) regarding the confidentiality of patient medical records and information as well as Personally Identifiable Information (PII).
• Strong communication skills in both verbal and written.
• Excellent interpersonal skills.
• Proficient in Microsoft Office (MS word, Excel, PowerPoint Outlook and SharePoint).

 REQURED LICENSURE/CERTIFICATION

Maintains Heartsaver CPR AED certification through the American Heart Association.

• Verbal and written proficiency in Spanish is preferred.
• Prior experience in a detention/correctional or residential healthcare setting is preferred, not required.

• Facility Operates 24/7/365; an employee may be required to respond during an emergency activation.
• Ability to work non-traditional hours including evenings, as well as weekends and holidays. Night shifts may be requested at times based on mission needs but are generally not required. (Site specific).
• The work requires some physical exertion, such as long periods of standing; walking or jogging unaided over rough, uneven, or rocky surfaces; recurring bending, crouching, stooping, stretching, reaching, or similar activities; or recurring lifting of moderately heavy patients or equipment.
• The work may require specific, but common, physical characteristics and abilities, such as agility and dexterity, visual, and hearing capabilities.
• Must be able to respond to any medical emergency in the facility, via foot, within four minutes and perform CPR/emergency care standing or kneeling.
• Ability to work efficiently under deadlines and pressure.
• Ability to keep up in a fast-paced environment.