This position will be a key member of Steward Health Care Network (SHCN), working within SHCN Referral Management (SHCN RM)
The role of the Referral Management Care Coordinator is to provide the following functions:
• Serve as liaison between members of specific health plans and primary care providers and specialists, to coordinate referrals and help members and providers navigate the Steward provider network
• Triage service requests
• Create and process referrals
• Use of a referral data tool to manage and retain care within the Steward network.
• Assist consumers with PCP and specialist selection
• Schedule PCP and specialist appointments
• Under the direction of the Medical Director and Sr. Manager, Insurance Products, communicates plan dispositions for out of network health care services members and PCP offices
• Ensure accurate and timely processing of all requests
• Receives incoming requests from physician practices and consumers.
• Verifies eligibility and coverage
• Obtains insurance referrals
• Assists with PCP selection
• Schedules patient appointments by contacting physician practices or scheduling directly in electronic medical record
• Registers consumers for system-wide events and screenings
• Tracks consumer responses to a variety of marketing venues
• Communicates with physician practices and patients as needed
• 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 established quality expectations e.g. confidentiality, accuracy, customer service and professionalism
• Covers triages function as needed
• Supports other departmental team members to assure turnaround time expectations are met.
• Communicates important information to team members
• Contributes to team efforts to improve workflow and efficiency
• Provide Outstanding Customer Service
• Goes 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
REQUIRED KNOWLEDGE & SKILLS:
• Exceptional Customer Service
• Strong communication and interpersonal skills
• Proficient with Microsoft Office programs
• Ability to meet deadlines in high-pressure environment
• Demonstrates effective interpersonal skills in intense situations
• 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.
• Customer service focused.
• Demonstrated understanding of the need for patient confidentiality in a HIPAA compliant environment.
• Self motivated
• Demonstrated ability to work independently and as part of a team.
• Knowledge of 3rd party payers
I. Education: Associates degree or equivalent amount of education and experience; Bachelors degree preferred
II. Experience (Type & Length): At least 1-3 years experience in healthcare related field. Medical office experience strongly preferred
III. Certification/Licensure: N/A
IV. Software/Hardware: MS Office, Excel, NEHEN. Emdeon, Medical Scheduling Software