Referral Management Specialist

2 weeks ago

Syracuse, New York, United States KPH Healthcare Services, Inc. Full time

KPH Healthcare Services, Inc.

- Referral Management Specialist -

Location: Syracuse, New York


Overview:

The Referral Management Specialist is a skilled professional responsible for overseeing and facilitating the referral intake process.


Key Responsibilities:
  • Efficiently communicates with referral sources such as clinical liaisons, discharge planners, and medical social workers to relay patient insurance benefits and coverage status for requested services.
  • Engages with insurance representatives, agency personnel, patients, and their families to clarify the proposed treatment plans and ensure safe discharge procedures.
  • Explains available options to achieve favorable financial outcomes for patients.
  • Secures all necessary authorizations from insurance providers and meticulously documents all relevant information within the KPH Healthcare Services system.
  • Informs the healthcare team promptly once authorization is granted, indicating readiness to proceed with the referral.
  • Participates in the Patient Referral Huddle Process, collaborating with the healthcare team to review pending referrals and identify outstanding requirements for successful transitions.
  • Maintains confidentiality and adheres to HIPAA regulations regarding patient information and proprietary company data.
  • Builds and nurtures positive relationships with both internal and external staff.
  • Assists referral sources in arranging necessary medical supplies or services to ensure a smooth transition for patients.
  • Collaborates with Marketing, Account Executives, and Pharmacy Staff to address promotional and educational initiatives related to insurance plans and potential changes.
  • Completes all mandatory training programs and performs additional duties as assigned.

Qualifications:

Educational Background:
High School Diploma or Equivalent.

Preferred Experience:
Minimum of one year in an intake role or a comparable combination of education and experience in the home healthcare sector. Familiarity with the insurance approval and authorization process is essential.


Employment Conditions:
  • Drug testing.
  • Ongoing monitoring for exclusions and sanctions.
  • Compliance with any additional eligibility criteria specific to the position.

Required Training:
  • HIPAA Privacy & Security Course.
  • Fraud, Waste, and Abuse Course.

Essential Skills:
  • Exceptional attention to detail and strong customer service abilities.
  • Excellent interpersonal and communication skills, both verbal and written.
  • Proficient in PC usage, particularly in Excel.
  • Ability to work independently and manage multiple priorities effectively.

Personal Attributes:
  • Innovative and open-minded, capable of identifying opportunities and developing creative solutions.
  • Goal-oriented and committed to achieving results while fostering a culture of continuous improvement.
  • Supportive and positive, inspiring confidence in others and contributing to a collaborative work environment.
  • Adaptable to changing business needs and able to perform under pressure.

Compensation:

Compensation will be determined based on various factors, including relevant skills, experience, and education.

KPH Healthcare Services, Inc. is a multistate organization that complies with all local, state, and federal regulations regarding minimum wage requirements.

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