Referral Specialist - #1403002

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Description

JOB DESCRIPTION – Referral Center Coordinator I/II

I. Job Summary / Job Purpose

The Referral Center Coordinator I/II works with patients and clinics requiring a referral, to ensure patients’ referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.

II. Key Responsibilities

• Set up appointments and coordinate external specialty clinic visits
• Gather, verify, and process Outgoing referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
• Monitor and maintain designated referral queue in an organized and efficient manner
• Coordinate flow of information between referring medical clinic and specialist office to secure a valid referral for clinic patient.
• Enter referrals, documents communications and action into the system, as appropriate.
• Notify physician(s) and patient when referral is denied, or if additional information is needed.
• Develop and maintain database of referral physician offices preferred by each physician within the system.
• Consult referring practice with complaint resolution and solutions related to patient referrals.
• Maintain performance and quality standards based on established Patient Navigation Center metrics including turn-around times
• Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction
• Perform other duties as assigned by the coordination center manager or director.
  
  

III. EngageMED Core Expectations

At EngageMED, Our Purpose Is To Deliver Strategies And Solutions To Impact The Success Of Practices. We Expect All Our Employees To Live The Values Of Integrity, Respect, Innovation And Service

• Honoring and caring for the dignity of all persons in mind, body, and spirit
• Ensuring the highest quality of care for those we serve
• Working together as a team to achieve our goals
• Improving continuously by listening, and asking for and responding to feedback
• Seeking new and better ways to meet the needs of those we serve
• Using our resources wisely
• Understanding how each of our roles contributes to the success of EngageMED.
  
  

IV. Core Job Competencies

Core EngageMED Behaviors: The following behaviors have been identified as critical to all staff roles at EngageMED:

• Teamwork Orientation: works cooperatively & collaboratively with others toward the accomplishment of shared goals.
• Service Orientation: desire to serve and focus one’s efforts on discovering and meeting the needs of internal and external customers.
• Achieves Results: reflects a drive to achieve and outperform. Continuously looking for improvements. Accepts responsibility for actions and results.
• Learning and Growth: has a commitment to continuous professional and organizational learning
• Communication: practices attentive and active listening and can restate opinions of others; communicates messages in a way that has the desired effect.
  
  

Role-Specific Behaviors: these additional behaviors are necessary in the role:

• Knowledge of clinic referral and scheduling processes and billing/authorization requirements.
• Knowledge of federal and state pay requirements, including Medicare, Medicare Advantage, Medicaid, other Government and Commercial payers, HMO/PPO Contracts.
• Ability to communicate effectively and to maintain strict confidentiality.
• Ability to respond to people and issues promptly and appropriately, to resolve problems.
• A team player who handles multiple projects simultaneously in a fast-paced environment.
• Possess a strong work ethic and a high level of professionalism.
  
  

Skills, Knowledge Or Abilities Critical To This Role

• Language Ability: Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to common inquiries or complaints from groups of managers, clients, customers, and the general public.
• Math Ability: Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
• Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Computer Skills: Preferred proficiency in: Google Mail, Docs, Sheets; Microsoft Word, Excel, Outlook; Internet navigation, Healthcare payer portals
• Knowledge of eCW, NextGen, Cerner & Epic preferred
  
  

Qualifications

V. Job Requirements / Qualifications

• Education / Accreditation / Licensure (required & preferred):
• High school diploma or equivalent required.
• Experience (required and preferred):
• Referral Coordinator I: 1+ years of customer service experience, preferably in a healthcare or insurance environment.
• Referral Coordinator II: 4+ years of customer service experience, preferably in a healthcare or insurance environment.
• Bi-lingual a plus.
  
  

VI. Disclaimers

• This job description reflects EngageMED’s assignment of essential functions, it does not prescribe or restrict the tasks that may be assigned.
• Critical features of this job are listed above. They may be subject to change at any time due to reasonable accommodation or other reasons.
• This role is intended to be worked from on-site at EngageMED corporate office but may be asked to assist in remote operations during times of inclement weather or other extenuating circumstances.