Referral Coordinator

This position is designed to support the Oregon Rural Health Transformation Program, for which final budget details are currently being negotiated with the Oregon Health Authority. Hiring will be contingent on funding being disbursed.

SUMMARY OF MAJOR FUNCTIONS

The Coquille Indian Tribe operates the Ko\-Kwel Wellness Center (KWC) with clinics located in Coos Bay and Eugene, Oregon. The KWC offers primary care, dental, pharmacy, nutrition, physical and massage therapy, behavioral health, and substance use disorder services. The Referral and Prior Authorization Coordinator supports KWC providers and care teams by managing the referral process for patients requiring specialty care, diagnostic testing, or other services. Referrals may be internal between KWC providers or external between KWC and outside providers. The position ensures timely processing of referrals, obtains insurance prior authorizations when required, and coordinates communication between patients, providers (referring and referred), and insurers to support continuity of care.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Referral Management

• Receive and process internal and external referral orders from providers
• Coordinate scheduling internally within the KWC and externally with specialty clinics and providers

2

• Track referrals from initiation through completion to ensure patients receive recommended care
• Work with providers to renew referrals as necessary
• Maintain accurate documentation in the electronic health record (EHR)

Prior Authorizations and Insurance

• Verify insurance eligibility and referral requirements
• Obtain prior authorizations when required by payer guidelines and create prior authorizations through insurance portals (e.g., Evicore, OneHealth Port, Availity, OneHealth Care) as required
• Submit necessary clinical documentation to specialty clinics or insurance carriers
• Follow up on pending authorizations and resolve denials when appropriate

Patient and Client Coordination

• Contact patients and clients to explain referral instructions and scheduling details
• Assist patients and clients in navigating specialty care appointments
• Provide preparation instructions for diagnostic tests or specialty visits
• Address patient and client questions related to referrals and next steps in care

Provider and Care Team Support

• Communicate referral status updates with providers, medical assistants, and care teams
• Coordinate with referred providers and clinics to ensure timely access for patients and clients
• Assist providers with referral diagnosis codes and documentation requirements

Documentation and Compliance

• Maintain referral tracking logs and EHR documentation
• Ensure compliance with HIPAA and KWC policies
• Assist with quality improvement initiatives related to referral completion rates and care coordination metrics

The above statements reflect the general duties considered necessary to describe the principal functions of the job and are not intended to be an exhaustive list of all responsibilities. Other duties may be assigned.

PHYSICAL REQUIREMENTS

This position requires the ability to communicate effectively orally and in writing. Working at a computer terminal and performing repetitive movements of the wrists, hands, and/or fingers is required. Duties may involve walking, climbing, balancing, raising or lowering objects, and occasionally lifting up to fifty pounds. The position may require standing or sitting for extended periods, stooping, kneeling, crouching, or crawling. Work is performed primarily indoors in an office environment. If remote work is authorized, a secure and reliable internet connection is required at no cost to the Tribe. Local, statewide, or national travel may be required. The individual must be able to perform essential duties with or without reasonable accommodation without posing a safety risk to self or others.

3

KNOWLEDGE, SKILLS, AND ABILITIES

• Excellent oral and written communication skills with strengths in collaboration, team building, and problem solving
• Ability to convey a calm, respectful, and supportive demeanor in stressful or emotionally charged situations
• Ability to foster an inclusive environment where diversity and individual differences are valued
• Ability to make independent decisions in accordance with established regulations, policies and procedures
• Strong organizational skills and ability to set priorities and exercise sound judgment
• Ability to work cooperatively across departments and build effective working relationships
• Ability to work within an electronic health records system and/or electronic patient management system.
• Working knowledge of medical terminology

QUALIFICATIONS

• High School diploma or equivalent required
• Three (3\) years of experience in a medical office or healthcare administrative role required
• Experience with insurance referrals, prior authorizations, and care coordination processes preferred
• Experience with the Ochin/Epic electronic health record (EHR) system and understanding of referral work queues preferred
• Ability to collaborate professionally and effectively with internal and external partners
• Experience working for a tribe or tribal organization preferred
• First Aid, CPR, and QPR certification required or ability to obtain within ninety days
• Current and valid driver’s license in good standing with no insurability restrictions