Referral Management Care Coordinator
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care. In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients. With Steward in the community, all residents can be sure that there is a world class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
This position will be a key member of Steward Health Care Network (SHCN), working within SHCN Referral Management (SHCN RM).
- 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 Steward Provider Network.
- Creates and processes referrals.
- Uses a referral data tool to manage and retain care within the Steward network.
- Assists 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 to members and PCP offices.
- Ensures accurate and timely processing of all requests.
- Receives incoming requests from physician practices and consumers.
- Verifies eligibility and coverage.
- 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 triage function as needed.
- 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
- Associate degree or equivalent amount of education and experience; Bachelor’s degree preferred.
Years of Experience:
- At least 1-3 years’ experience in a healthcare-related field. Medical office experience strongly preferred.
- Fluency in a foreign language desirable; particularly Spanish, Russian, Portuguese, Haitian Creole, or Vietnamese.
- 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.
- Demonstrated ability to work independently and as part of a team.
- Knowledge of 3rd party payers.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled