Referral Coordinator

2 weeks ago

North Little Rock, Arkansas, United States EngageMED, Inc. Full time
Job Summary

We are seeking a highly skilled Referral Navigator to join our team at EngageMED, Inc. As a Referral Navigator, you will play a critical role in ensuring that patients receive timely and effective care by coordinating referrals to specialty services.

Key Responsibilities
  • Screen and assess referrals to ensure correct patient demographics, care providers, and insurance eligibility.
  • Obtain PCP referrals and/or prior authorizations as required by insurance payers.
  • Direct/assign referrals to the appropriate Referral Coordinator Specialist promptly.
  • Enter referrals, document communications, and actions into the system as necessary.
  • Consult with referring practices to resolve complaints and provide solutions related to patient referrals.
  • Maintain performance and quality standards based on established EngageMED metrics, including turn-around times.
  • Identify trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement, and call reduction.
EngageMED Core Expectations

At EngageMED, we expect all our employees to live the values of Reverence, Integrity, Compassion, and Excellence at work by:

  • Honoring and caring for the dignity of all persons in mind, body, and spirit.
  • Ensuring the highest quality of care for those we serve.
  • Working together as a team to achieve our goals.
  • Improving continuously by listening, and asking for and responding to feedback.
  • Seeking new and better ways to meet the needs of those we serve.
  • Using our resources wisely.
  • Understanding how each of our roles contributes to the success of EngageMED.
Core Job Competencies

Core EngageMED Behaviors: The following behaviors have been identified as critical to all staff roles at EngageMED:

  • Teamwork Orientation: works cooperatively and collaboratively with others toward the accomplishment of shared goals.
  • Service Orientation: desire to serve and focus one's efforts on discovering and meeting the needs of internal and external customers.
  • Achieves Results: reflects a drive to achieve and outperform. Continuously looking for improvements. Accepts responsibility for actions and results.
  • Learning and Growth: has a commitment to continuous professional and organizational learning.
  • Communication: practices attentive and active listening and can restate opinions of others; communicates messages in a way that has the desired effect.
Role-Specific Behaviors

Role-Specific Behaviors: The following behaviors are necessary in this role:

  • Proficient knowledge of clinic referral and scheduling processes and billing/authorization requirements.
  • Knowledge of federal and state pay requirements, including Medicare, DSHS, HMO/PPO Contracts.
  • Ability to communicate effectively and to maintain strict confidentiality.
  • Ability to respond to people and issues promptly and appropriately, to resolve problems.
  • A team player who handles multiple projects simultaneously in a fast-paced environment.
  • Possess a strong work ethic and a high level of professionalism.
Skills, Knowledge or Abilities

The following skills, knowledge, or abilities are critical to this role:

  • Language Ability: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to common inquiries or complaints from groups of managers, clients, customers, and the general public.
  • Math Ability: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
  • Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
  • Computer Skills: Must be proficient with the Microsoft Office Suite, Internet navigation, database management.
  • EMR: Knowledgeable of eClinical Works and willing to learn/access other EMR portals as necessary to maintain continuity of care while upholding HIPAA standards.
Qualifications

The following qualifications are required for this role:

  • High school diploma or equivalent required.
  • Excellent communication skills.
  • Proven ability to deal professionally with all stakeholders involved in the referral process.
  • Energetic and motivational individual with a positive attitude and outcomes.
  • Skills in multi-tasking, efficiency operations, and teamwork.
  • 5+ years of healthcare experience.
  • 2+ years knowledge/experience of government and commercial healthcare insurance plans.

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