Referral Coordinator Lead - Trinity Health - IHA : Job Details

POSITION DESCRIPTION:Responsible for reviewing, submitting, monitoring and responding to issues, referrals and referral authorizations for IHA patients. Reviews patient medical history to identify supporting documentation in the patient chart relevant to the referral; contacts insurance companies and obtains authorization for referral. Collaborates with supervision and management to ensure department's efficiency. ESSENTIAL JOB FUNCTIONS:In addition to Referral Coordinator functions (see below), performs these additional Lead functions:

Collaborates with the Referral Coordinator Supervisor, Service Center Supervisors, and Program Manager of the Primary Care PPSC to make the department more efficient.

Works with management on incoming schedule changes and PTO requests.

Manages incoming questions from coworkers, both administrative and workflow-related.

Communicates with clinical offices and Practice Managers to better align workflow.

Maintains protocol and workflow documentation.

Manages ongoing training of new and existing staff in conjunction with Supervisor.

Creates and disperses trackers for data collection.

Performs analysis of data collection.

Allocates office assignments.

Facilitates job duties to peers.

Monitors Referral Coordinators' in-baskets to check for accuracy and productivity.

Provides input on introductory and annual performance reviews.

Covers coworkers during call-offs and scheduled PTO, if needed.

Represents the department at leadership meetings.

Referral Coordinator functions:

Contacts insurance companies via appropriate methods and obtains authorizations if applicable for specific plans.

Educates patients and staff with pertinent referral and insurance information.

Obtains urgent authorizations same day and next day, if needed.

Assists patients in scheduling appointments with specialist and helps resolve referral issues.

Generates referral information for physicians, patients and health plans.

Acts as a liaison among providers, patients and health plan administrators.

Responsible for reviewing and submitting clinical information to health plan case managers for special referral pre-certification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up, as necessary.

Communicates referral status to patients and physicians; ensures that referrals have been processed accurately and in a timely manner to coincide with patient treatment plan.

Answers incoming calls that are relevant to referrals.

Provides outreach to patients when appropriate for details on appointments and/or insurance information.

Secures verification of insurance through payor sites and notifies patients if there needs to be changes made prior to processing the referral.

Test tracks the referrals until fulfilled by the patient. This would include outbound calls to patients and external specialists for updates.

At times, may need to request external specialist office visit notes to be shared with the referring provider.

Updates information in the patient medical record (EMR) with approval or declination of information; follows up with the primary care physician as to the status and/or issues with the referral authorization.

Communicates with the ordering provider for next steps with practice support staff and representatives of insurance companies.

Participates in data collection of insurance companies.

Supports other offices, attends required meetings and training, and participates in committees, as requested.

Assists with special projects and assumes additional duties as assigned.

ORGANIZATIONAL EXPECTATIONS:

Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of Trinity Health Medical Group.

Must be able to work effectively as a member of the Referral Coordinator team.

Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

Successfully completes all relevant organizational training and adheres to Trinity Health Medical Group standard of care as outlined in the Trinity Health Code of Conduct.

Maintains knowledge of and complies with Trinity Health Medical Group standards, policies and procedures.

Maintains general knowledge of Trinity Health Medical Group office services and in the use of all relevant office equipment, computer and manual systems.

Maintains strict confidentiality in compliance with Trinity Health Medical Group and HIPAA guidelines.

Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.

Uses resources efficiently.

If applicable, responsible for ongoing professional development - maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.

MEASURED BY:Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position. ESSENTIAL QUALIFICATIONS:EDUCATION: Undergraduate degree or Associate's degree in health care or a related field and specialized training or equivalent combination of education and experience. CREDENTIALS/LICENSURE: Prior Authorization Certified Specialist (PACS) certification recommended.MINIMUM EXPERIENCE: Minimum 3 years' experience with insurance referrals, prior authorization or other relevant medical office experience.POSITION REQUIREMENTS (ABILITIES & SKILLS):

Strong knowledge in medical terminology.

Proficient knowledge of major health plans and insurance processes.

Strong knowledge in Specialty and Primary medications and drug classifications.

Knowledge of pharmacy benefits and third-party vendors.

Knowledge in ICD 10.

Ability to successfully process medication authorizations for up to 5+ offices across multiple divisions.

Proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records (EMR), EPIC and CoverMyMeds, email, e-learning, intranet and computer navigation. Knowledgeable in Microsoft 365 (especially Excel) preferred. Ability to use other software as required while performing the essential functions of the job.

Excellent communication skills in both written and verbal forms, including proper phone etiquette. Ability to read, understand and respond to detailed written and oral instructions.

Ability to speak before groups of people, either in-person or virtually.

Ability to communicate with insurance companies, both written and verbally.

Ability to effectively and professionally work with and communicate with various levels of organizational members and diverse populations including IHA staff, senior-level management, providers, patients, vendors, family members, outside customers and community groups.

Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.

Ability to document steps, processes and procedures.

Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.

Good organizational and time management skills to effectively juggle multiple priorities, time constraints and ever-changing medical situations.

Ability to exercise sound judgement and problem-solving skills.

Ability to perform mathematical calculations needed during the course of performing basic job duties.

Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations.

Ability to handle patient and organizational information in a confidential manner.

Ability to travel to other office/practice sites and meeting and training locations.

Successful completion of IHA competency-based program within introductory and training period.

MINIMUM PHYSICAL EXPECTATIONS:

Physical activity that often requires keyboarding, phone work and charting.

Physical activity that often requires time working on a computer.

Physical activity that sometimes requires lifting up to 5 lbs.

Physical activity that sometimes requires walking.

Specific vision abilities required include close vision, depth perception, color vision, peripheral vision and the ability to adjust and focus.

Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.

Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

MINIMUM ENVIRONMENTAL EXPECTATIONS:This job operates in a typical office environment which involves frequent interruptions and significant interaction with people (some of whom are scared, hurt and/or ill) which can be stressful and result in competing priorities.