Job Summary

This role is responsible for managing the care coordination process surrounding specialist referrals for patients, ensuring that appropriate communication is provided to the specialist and the patient, as well as ensuring follow-up information is received from the specialist for the referring provider to review. This role will gather, process, and maintain patient medical records in a manner compliant with ethical, legal, and regulatory requirements.

Duties and Responsibilities

• Monitor the referral management system for new referral requests, monitoring of referrals which are in progress and completing the documentation loop in the referral process.
• Provide patients with verbal and written instructions (preferably delivered electronically when possible), along with any specific instructions or requirements provided by the specialist office.
• Monitor changes in PCP assignment that could invalidate existing referrals and handling appropriately.
• Monitor “in progress” referrals to ensure the patient is seen by the specialist, rescheduling when necessary.
• Provide excellent customer service to all patients, ensuring they have appropriate and necessary information and instructions while aiding them in coordination of specialist referrals.
• Communicate to the care team when patients refuse appointments, or no show more than once with a specialist.
• Post appointment, the staff member is responsible for following up with the specialist provider to obtain copies of their documentation if not previously received. Referrals may not be completed until the documentation is received in the chart.
• Trouble shooting and alerting the providers or management of coverage issues or barriers to scheduling requested specialist referrals.
• Responsible for relaying appropriate coverage information to the patients.
• Maintain up-to-date knowledge of participating insurance plans including referral requirements, eligibility requirements and specifications, copayments, coinsurance, deductible, pre-existing, and plan limitations, in and out of network benefits.
• Maintain a general level of knowledge of appropriate triage of patient and physician needs with the ability to prioritize effectively.
• Supply staff with required forms and documents.
• Protect medical records from loss or defacement prior to the end of retention periods.
• Process records accurately, and in a timely fashion.
• Maintain strict confidentiality of all medical records.

Minimum Qualifications

• High school diploma or equivalent required.
• 2-3 years’ experience with insurance verifications and benefits preferred.
• 2-3 years’ experience with insurance verifications and benefits preferred.
• Personal and professional passion to help improve healthcare delivery.
• Ability to multi-task, highly organized with excellent communication, and customer service skills.
• Excellent computer skills, including knowledge of Microsoft Office.
• Strong attention to detail.
• Knowledge of medical terminology.

Working conditions

This job operates in a remote location from your home location.  This role requires a dedicated, quiet workspace with the ability to adhere to HIPPA and other privacy policies.  A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role.

Physical requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Constantly operates computer, keyboard, phone, and other general office equipment.

Direct reports

None.