Referral Coordinator - Steward Health Care

Position Purpose:

This position will be a key member of Steward Health Care Network (SHCN), working within the SHCN Concierge Referral Management team. The position works predominately within one market in order to be the most effective in identifying the appropriate provider given an understanding of the local geography and landscape.

Key Responsibilities:

• Performs the daily operations of Concierge Referral Management identified market. Serves as a back-up for additional markets, as needed.
• Creates and processes referrals and Radiology prior authorizations, consisting of but not limited to:
  • Receives incoming requests from practices and consumers via efax, phone, or workflow tool
  • Obtains authorization from an insurance plan if the payer requires
  • Verifies eligibility and coverage
  • Finds a highly aligned provider to engage a specialist or facility consult using the highly aligned provider listing.
  • Schedule the appointment with the specialist by contacting the specialist practice or scheduling directly in the electronic medical record.
  • Notifies PCP/referring practice of the date, time, and specialist the patient will see.
  • Confirms availability with patients and assists in scheduling the patient with the specialist.
  • Engages with Medical Directors, as necessary,to process referrals
• Uses referral data tool to manage and retain care within the Steward network whenever appropriate.
• Under the direction of the Medical Director and Manager, communicates plan dispositions for out-of-network health care services to members and PCP offices.
• Confirms appointments and/or referrals with physician practices and consumers.
• Assures that all necessary documentation occurs in a timely manner.
• Achieves established performance targets.
• Meets establish quality expectations; eg., confidentiality, accuracy, customer service, and professionalism.
• Supports other departmental team members to ensure turn around time expectations are met.
• Communicates important information to team members.
• Contributes to team efforts to improve workflow and efficiency.
• Proides Outstanding Customer Service, going the "extra mile" to assure that customer expectations are met.
• Assists with other projects within the department on an "as needed" basis.
• Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible and courteous environment.
• Commits to recognize and respect cultural diversity for all customers (internal and external).
• Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs, and ages utilizing interpreters when needed.
• Performs other duties as assigned.

Education:

• Associate degree or equivalent amount of education and experience; Bachelor's degree preferred.

Years of Experience:

• At least 2-4 years' experience in a healthcare-related field. Medical office experience strongly preferred.

Specialized Knowledge:

• Fluency in a foreign language desirable; particularly Spanish, Russian, Portuguese, Haitian Creole, or Vietnamese.
• Exceptional Customer Service.
• Strong Communication and interpersonal skills; particularly intense situations.
• Ability to meet deadlines in a high-pressure environment.
• Knowledge of managed care concepts and medical terminology.
• Ability to multi-task and work with multiple software applications.
• Knowledge of insurance, medical office practice, and/or referral processing.
• Demonstrated ability to process insurance referrals and/or schedule physician appointments.
• Excellent organizational skills and attention to detail.
• Demonstrated understanding of the need for patient confidentiality in a HIPAA-compliant environment.
• Demonstrated the ability to work independently and as part of a team.
• Knowledge of 3rd party payers.