Referral Management Clerk
Found in: Resume Library US A2 - 2 weeks ago
Compass Government Solutions is seeking entry level General Clerks (to include roles as Referral Management and Clear and Legible Reporting Clerks) with customer service experience in Tacoma, Washington.
Veterans and Military Spouses Encouraged to Apply
Civilian position supporting the military community
Monday through Friday days
Job Overview:
The Puget Sound Military Appointing Center (PSMAC) is a centralized services center that serves as the primary point of contact for PSMHS beneficiaries for PAS, RMS, and CLRS as they seek healthcare services, and is therefore a critically important resource in our healthcare delivery system.
Call center that manages inbound and outbound calls from beneficiaries, validates beneficiary eligibility, schedules, cancels, and reschedules patient appointments in order to provide timely access to quality healthcare.
Provide outbound calls in order to schedule specialty appointments for beneficiaries who have received a direct care specialty referral.
RMS processing supports the timely scheduling of specialty care referrals ordered by MTF HCPs.
RMS services span a range of functions to include, but not limited to: identifications of specialty referrals to be deferred to the network, ensuring processing in accordance with DHA timeliness, and tracking status of network referrals.
Review of each MTF generated referral and determining a disposition as either "Appoint to MTF" or "Defer to Network (DTN)" based on specific MTF specialty clinic capabilities, capacities, and DHA access to care standards.
Maximizing the retention of specialty care within the MHS to support the readiness of the Medical Force, within capability and capacity parameters.
Additional contracted services include processing Secure Message Service (SMS) transmittal requests for appointments, drive-time mapping capabilities in support of specialty care appointing, as well as outbound letters to beneficiaries referred for MTF specialty care.
Duties
Disposition all routine referrals as either Appoint to MTF, Defer to Network, or route to MTF Referral Management Center (RMC) IAW standardized PSMHS business policy.
Document and report complaints received, errors found, and the specific corrective action taken by the contractor. Errors shall include those identified by patients/beneficiaries, clinic and/or MTF staff, and direct to the contractor.
Process incoming referrals (ROFR) from the MCSC network providers and MTFs according to eMSM, DHA requirements and standardized guidelines.
Record and track status and disposition on all Prime/Select/VA/ ROFRs, MTF, and network referrals and communications received, per DHA and PSMHS business rules.
Review all referrals and appoint to MTF referrals, or return to requester based on policies and procedures.
Provide Monthly Reporting
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