Job Description
ESSENTIAL JOB DUTIES/RESPONSIBILITIES:
Serve as primary point of contact for incoming and outgoing patient referrals. Triage referrals, gather necessary information, ensure timely processing and assignment to appropriate providers.
Facilitates communication, collaboration, and coordination of care. Coordinating appointments, referrals, transitions of care between primary care, specialists, hospitals, and other healthcare settings, ensuring seamless transitions and continuity of care.
Schedules patients utilizing coordinated provider list (CPL), makes all necessary arrangements related to the appointment, notify patients of appointment information: date, time, and location.
Uses web-based insurance platforms to generate referral authorizations.
Effectively communicates the physicians/clinicians needs or outstanding items to patients.
Follows all referrals through to completed appointment and obtains all documentation related to appointment, uploading into organization’s medical record system for physician review prior to PCP follow-up appointment.
Ensures any missed external appointments are rescheduled and communicated to the PCP.
Addresses referral-related phone calls from patients, providers, etc. Completes and addresses phone messages in a timely manner.
Provides extraordinary customer service to all internal and external customers.
Performs other related duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES:
Knowledge of medical terminology, CPT, HCPCS and ICD coding desired
An understanding of the company’s patient population, including the complexities of Medicare programs
Exceptional organizational skills with the ability to effectively prioritize and complete tasks in a timely manner.
An understanding of the company’s patient population, including the complexities of Medicare programs
Detail-oriented with the ability to multi-task.
Able to exercise proper phone etiquette.
Ability to navigate proficiently through computer software systems & use technology.
Ability to work well with patients, colleagues, physicians and other personnel in a professional manner.
Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, database, and presentation software.
Spoken and written fluency in English; bilingual preferred.
Flexible to work evening, weekends and/or holidays as needed
EDUCATION AND EXPERIENCE CRITERIA:
High School diploma or equivalent required
A minimum of 1 year of referral experience in a healthcare setting required.
Experience with web-based insurance sites and obtaining referrals/authorizations for multiple payors preferred.
Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred
Healthcare experience within the Medicare Advantage population preferred.
Medical Assistant certification preferred
CPR for Healthcare Providers is preferred