Medical Referral Specialist - Kalihi Palama Health Center

Primary Purpose:

The person in this position is a member of the Patient Centered Health Care Home team where each team member plays an integral role in providing patient-centered health care. S/he performs utilization management activities within the health center; monitors patient referral insurance paperwork to assure timely processing and accurate authorization of referrals to external agencies and/or consultants.

Essential Duties:

• Perform Utilization Management Functions:
• Monitor patient insurance status to insure timely and accurate authorization of referrals for service and drug assistance.
• Communicate by telephone and mail with clients regarding appropriate use of medical benefits as it pertains to existing referrals
• Support physicians and their staff to accurately complete referral paperwork and drug assistance authorization.
• Create and maintain computer and/or manual referral logs
• Verify patient eligibility for insurance coverage, under some instances will authorize approval for referrals. (ie: as insurance plan guidelines permit).
• Verify participation with various insurance plans to assure maximum reimbursement and most cost effective selection of referral services source.
• Follows up on patient referrals by calling the specialists
• Tracks open orders as necessary
• Tracks specialists performance
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• Follow KPHC Administrative Guidelines to promote effective and efficient patient care.
• Make thorough, accurate and timely documentation.
• Answer phones within a reasonable amount of time and take accurate messages.
• Maintain patient confidentiality.
• Support cost containment effort.

Regular and reliable on-site attendance is required.

Other Duties:

Perform other related task as directed.

Observe safety and security procedures; determine appropriate actions beyond guidelines; report potentially unsafe conditions; use equipment and materials properly.

Minimum Qualification Requirements:

Skills/Knowledge:

• Ability to add, subtracts, multiply, and divides 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.
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Ability to deal with problems involving several concrete variables in standardized situations

Education:

High School Diploma or GED required, Post-secondary education preferred.

Formal training in Medical Terminology required.

Certified or registered Medical Assistant preferred.

Experience:

Experience in clinical setting required (any capacity).

Previous experience in utilization management preferred.

Experience in CPT, ICD9 coding preferred.

Kalihi-Palama Health Center is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.