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Referral Management Coordinator

2 months ago

Plano, Texas, United States Concentra Full time
Job Summary

We are seeking a highly skilled Referral Management Coordinator to join our team at Concentra. As a key member of our healthcare team, you will be responsible for maintaining high standards of quality and delivering exceptional patient experiences.

Key Responsibilities
  • Process referrals requests and authorizations while working closely with physicians, employers, and payors.
  • Provide customer service and support to patients, payors, and employers, ensuring a positive impact on the cost and quality of care rendered.
  • Review, process, and support specialist referral requests from Concentra sites, ensuring compliance with market-defined requirements.
  • Obtain authorization for specialist referrals and schedule appointments accordingly.
  • Ensure the use of appropriate networks and Concentra Advanced Specialists when applicable.
  • Provide necessary information, such as medical records and prescriptions, to payors.
  • Communicate with stakeholders, payors, employers, and patients as required.
  • Record all relevant information via the OA/CR module of OccuSource, adhering to Concentra policies.
  • Build relationships with provider, employer, and payor communities.
  • Identify trends or patterns in missed capture and opportunities to gain capture, communicating these ideas and trends to Lead and Supervisor.
  • Handle calls according to departmental call guidelines.
  • Participate in quality assurance processes, including audits, case reviews, and training sessions.
Requirements
  • High school diploma or GED equivalent.
  • Associated degree from an accredited college preferred.
  • At least one year of demonstrated experience in a medical environment, with a focus on service delivery (referrals, claims, insurance, billing, etc.).
  • Experience with Worker's Compensation preferred.
  • Proficiency with scheduling/insurance verification software.
Skills and Competencies
  • Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative, and Flexibility.
  • The ability to handle sensitive and confidential information, including HIPAA and PHI, in accordance with federal and state laws and company policies.
  • Familiarity with Microsoft Excel, Outlook, and Word.
  • Excellent communication skills and ability to communicate effectively with colleagues at all levels of the organization.
  • Proper business etiquette and diplomacy skills.
  • Excellent time management skills, including the ability to multitask and prioritize in a fast-paced environment.
  • Ability to build and maintain productive business relationships.
  • Exemplary problem-solving skills and ability to make decisions using logic.
  • Outstanding customer service skills and ability to deal with people in a professional manner.
  • Excellent writing and documentation skills.
  • Strong attention to detail.
  • Ability to work independently and handle special projects.
  • Ability to handle multiple tasks, projects, duties, and priorities when assigned.