Referral Center Coordinator - EngageMED Corporate

Description

Receptionist and Referral Center Coordinator I works with patients and clinics requiring a referral, to ensure patient’s referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.

The Referral Center Coordinator I works with patients and clinics requiring a referral, to ensure patient’s referral needs are fulfilled for specialty service office visits. Processes referrals, authorizations and pre-certifications for patients, to ensure timely reimbursement.

• Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
• Monitor and maintain designated referral queue in an organized and efficient manner
• Set up appointments and coordinate clinic visits
• Coordinate flow of information between referring medical clinic and specialist office to secure a valid referral for clinic patient.
• Enter referrals, documents communications and action into the system, as appropriate.
• Notify physician(s) and patient when referral is denied, or if additional information is needed.
• Develop and maintain database of referral physician offices preferred by each physician within the system.
• Consult referring practice with complaint resolution and solutions related to patient referrals.
• Perform other duties as assigned by the coordination center manager or director.
• Maintain performance and quality standards based on established call center metrics including turn‑around times
• Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction

At Engage

MED, 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 Engage
  
  MED.

Core Engage

MED Behaviors:
The following behaviors have been identified as critical to all staff roles at Engage

MED:

• Teamwork Orientation: works cooperatively & 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.

• 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.

• 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…