Healthcare Referral Specialist
3 weeks ago
POSITION DESCRIPTION
POSITION: Patient Care Referral Coordinator
DEPARTMENT: Primary Care
REPORTS TO: Director of Compliance and Risk Management
TYPE: Full Time
Overview:
Under the direct oversight of the Clinical Health Director, the Patient Care Referral Coordinator is responsible for overseeing the referral and authorization processes for all patients within the health center.
Key Responsibilities
Direct Patient Services (50%):
- Ensure the accuracy and completeness of referral and admission records by initiating and tracking all internal and external referrals for health center patients.
- Act as an advocate for patients in navigating access to non-primary care services and assist in coordinating the appeals process for any denied services.
Administrative Duties (50%):
- Maintain detailed and accurate records of referral activities to ensure compliance with visit frequency requirements as dictated by each payer.
- Analyze utilization and referral reports from all payors, identifying trends and patterns to report to management, and coordinate the dissemination of these reports to relevant stakeholders.
- Ensure that MCHC providers have access to documented referral protocols, policies, and procedures for all contracted MCOs and HMOs.
- Engage in outreach and educational initiatives aimed at attracting new members and retaining existing patients.
- Perform additional related responsibilities as assigned.
Accountability:
This position reports directly to the Director of Compliance and Risk Management.
Qualifications:
High School diploma with a minimum of two years of experience in case management and referral processes.
Demonstrated 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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