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Referral Management Specialist

2 months ago

Bethesda, Maryland, United States Zimmerman Associates, Inc Full time
Job Summary

Zimmerman Associates, Inc. is seeking a highly skilled Referral Management Specialist to support a government contract bid in the healthcare industry.

Key Responsibilities
  • Review referrals to ensure accuracy, completeness, and appropriateness, collaborating with healthcare teams to ensure proper use of the Direct Care System and civilian network resources.
  • Effectively communicate with patients, ordering providers, and other stakeholders to ensure timely and appropriate care.
  • Utilize medical terminology and knowledge of medical care criteria to interpret and apply guidelines, such as InterQual and Milliman Ambulatory Care Guidelines.
  • Manage and process referrals in a timely manner, adhering to established guidelines and timelines.
  • Collaborate with multidisciplinary personnel to ensure appropriateness of referrals and provide recommendations for improvement.
  • Document referrals and patient interactions in MHS-GENESIS, ensuring accurate and complete records.
  • Provide exceptional customer service, responding to patient inquiries and concerns in a timely and professional manner.
  • Stay up-to-date with changes in healthcare policies, procedures, and guidelines, applying this knowledge to improve referral management processes.
Requirements
  • Minimum of an Associate's degree and 2 years' experience in Utilization Management, Referral Management, Authorization/Denials, or Medical Claims Processing/Insurance Referral.
  • Knowledge of medical terminology, computer literacy, and ability to learn MHS, VA-DOD Sharing Program, TRICARE, HIPAA, and release of medical information.
  • Effective communication and people skills, with the ability to work in a fast-paced environment.
  • Superior customer service skills, with a focus on patient satisfaction and experience.
  • Excellent organizational skills, with the ability to manage time effectively, prioritize tasks, and set goals.
  • Knowledge of Microsoft Suite of Products, including Word, Excel, PowerPoint, Access, Outlook, and the Internet.
Working Conditions

This is an onsite employment opportunity, with consideration provided for teleworking after the successful completion of 120 days onsite.

Equal Opportunity Employer

Zimmerman Associates, Inc. is an equal opportunity employer, committed to diversity and inclusion in the workplace.