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Healthcare Referral Specialist

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:

Under the direct supervision 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 precise and comprehensive referral and admission tracking by initiating and following up on all internal and external referrals for health center patients.
  • Act as an advocate for patients, assisting them with access to non-primary care services and managing 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 set by each payer.
  • Analyze utilization and referral reports from all payors, identifying trends and patterns, and communicate findings to management while distributing reports to relevant stakeholders.
  • Ensure that documented referral protocols, policies, and procedures for all contracted MCOs and HMOs are accessible to health center providers.
  • Engage in outreach and educational initiatives aimed at attracting new members and retaining existing ones.
  • Perform additional related duties 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.

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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