Location: Steward Health Care Network - North
Posted Date: 1/14/2020
- Serves as liaison between members of specific health plans and primary care providers and specialists to coordinate referrals and help members and providers navigate the PrimaCARE, P.C. Provider Network.
- Creates and processes referrals.
- Uses a referral data tool to manage and retain care within the PrimaCARE, P.C. network.
- Ensures accurate and timely processing of all requests.
- Receives incoming requests from physician practices and patients.
- Verifies eligibility and coverage.
- Communicates with physician practices and patients as needed.
- Confirms referrals with physician practices and patients.
- Assures that all necessary documentation occurs in a timely manner.
- Achieves established performance targets.
- Meets established quality expectations; e.g., confidentiality, accuracy, customer service, and professionalism.
- Verify and update patients insurances.
- Assist in updating Providers in electronic medical records system (NPI, Provider Name, Address, etc..)
- Upload hard copy of Insurance Referrals from carriers.
- Submit and follow up all Out of Network Insurance request.
- Supports other departmental team members to ensure turnaround time expectations are met.
- Communicates important information to team members.
- Contributes to team efforts to improve workflow and efficiency.
- Provides Outstanding Customer Service, going the “extra mile” to assure that customer expectations are met.
- Assists with other projects within the department on an "as needed" basis.
- Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
- Commits to recognize and respect cultural diversity for all customers (internal and external).
- Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs, and ages, utilizing interpreters when needed.
- Performs other duties as assigned.
Education / Experience / Other Requirements
Years of Experience: