Job Description

Category:
Administrative/ Clerical

Facility:
Steward Health Care Network

Department:
Steward Health Care Network

Req Number:
52197

Job Details:

POSITION SUMMARY:

This position will be a key member of PrimaCARE, P.C. Referral Department

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.

REQUIRED KNOWLEDGE & SKILLS:

* 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.
* Demonstrated ability to work independently and as part of a team.
* Reliable.
* Knowledge of 3rd party payers.


EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

I. Education: Associate's degree or equivalent amount of education and experience; Bachelor's degree preferred.
II. Experience: At least 1-3 years' experience in a healthcare-related field. Medical office experience strongly preferred.
III. Software/Hardware: MS Office, Excel, NEHEN. Emdeon, Medical Scheduling Software.
IV. Other: Fluency in a foreign language desirable; particularly Spanish, Russian, Portuguese, Haitian Creole, or Vietnamese.



Application Instructions

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