Job Description

Category:
Administrative/ Clerical

Facility:
Steward Health Care Network

Department:
Steward Health Care Network

Req Number:
53715

Job Details:

POSITION SUMMARY:
This position will be a key member of Steward Health Care Network (SHCN), working within SHCN Referral Management (SHCN RM)

The role of the Referral Management Care Coordinator is to provide the following functions:
* Serve as liaison between members of specific health plans and primary care providers and specialists, to coordinate referrals and help members and providers navigate the Steward provider network
* Triage service requests
* Create and process referrals
* Use of a referral data tool to manage and retain care within the Steward network.
* Assist consumers with PCP and specialist selection
* Schedule PCP and specialist appointments
* Under the direction of the Medical Director and Sr. Manager, Insurance Products, communicates plan dispositions for out of network health care services members and PCP offices

KEY RESPONSIBILITIES:
* Ensure accurate and timely processing of all requests
* Receives incoming requests from physician practices and consumers.
* Verifies eligibility and coverage
* Obtains insurance referrals
* Assists with PCP selection
* Schedules patient appointments by contacting physician practices or scheduling directly in electronic medical record
* Registers consumers for system-wide events and screenings
* Tracks consumer responses to a variety of marketing venues
* Communicates with physician practices and patients as needed
* Confirms appointments and/or referrals with physician practices and consumers
* 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
* Covers triages function as needed
* Teamwork
* Supports other departmental team members to assure turnaround time expectations are met.
* Communicates important information to team members
* Contributes to team efforts to improve workflow and efficiency
* Provide Outstanding Customer Service
* Goes 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
* Proficient with Microsoft Office programs
* Ability to meet deadlines in high-pressure environment
* Demonstrates effective interpersonal skills in intense situations
* 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.
* Reliability
* Knowledge of 3rd party payers

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:
I. Education: Associates degree or equivalent amount of education and experience; Bachelors degree preferred
II. Experience (Type & Length): At least 1-3 years experience in healthcare related field. Medical office experience strongly preferred
III. Certification/Licensure: N/A
IV. Software/Hardware: MS Office, Excel, NEHEN. Emdeon, Medical Scheduling Software
V. Other: Fluency in a foreign language desirable e.g. Spanish, Russian, Portuguese, Haitian Creole and Vietnamese



Application Instructions

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