Job Description

Location: Steward Health Care Network - North
Posted Date: 1/14/2020

Key Responsibilities:

  • 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:

Specialized Knowledge:

  • Exceptional Customer Service.
  • Strong communication and interpersonal skills; particularly in intense situations.
  • Ability to meet deadlines in a high-pressure environment.
  • Knowledge of managed care concepts and medical terminology.
  • Ability to multi-task and work with multiple software applications.
  • Knowledge of insurance, medical office practice, and/or referral processing.
  • Demonstrated ability to process insurance referrals and/or schedule physician appointments.
  • Excellent organizational skills and attention to detail.
  • Customer service-focused.
  • Demonstrated understanding of the need for patient confidentiality in a HIPAA-compliant environment.
  • Self-motivated and reliable
  • Demonstrated ability to work independently and as part of a team.
  • Knowledge of 3rd party payers.

Application Instructions

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