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Healthcare Referral Coordinator

2 months ago

Boston, Massachusetts, United States Mattapan Community Health Center Inc Full time

POSITION DESCRIPTION

POSITION: Patient Care Referral Coordinator

DEPARTMENT: Primary Care

REPORTS TO: Director of Compliance and Risk Management

TYPE: Full Time

Overview:

The Patient Care Referral Coordinator is responsible for overseeing the referral and authorization processes for patients within the health center, ensuring seamless access to necessary services.

Key Responsibilities:

Direct Patient Services (50%):

  • Facilitate accurate and comprehensive referral and admission tracking by initiating and following up on all internal and external referrals for patients.
  • Act as a liaison for patients and managed care organizations (MCOs) or health maintenance organizations (HMOs) to ensure access to non-primary care services and assist in the appeals process for any denied services.

Administrative Duties (50%):

  • Maintain detailed and precise records of referral activities to comply with visit frequency requirements set by each payer.
  • Analyze utilization and referral reports from all payers, identifying trends and presenting findings to management while distributing relevant reports to stakeholders.
  • Ensure that documented referral protocols, policies, and procedures for all contracted MCOs and HMOs are accessible to providers.
  • Engage in outreach and educational initiatives aimed at attracting new members and retaining existing ones.
  • Perform additional related responsibilities as required.

Accountability:

This position reports directly to the Director of Compliance and Risk Management.

Qualifications:

High School diploma with at least two years of experience in case management and referral processes.

Proven understanding of healthcare principles and practices.

Exceptional communication and organizational skills are essential. Strong interpersonal skills and a professional demeanor are required. Proficiency in word processing and database management is preferred.


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