Referral Manager

Job Summary

 

This role directs and supervise all work activity related to the centralized referral team. Monitoring compliance to applicable policies and procedures to assure organizational goals, objectives, and KPI attainment are met for the department.  Working with Senior leadership throughout the company to continually improve workflow, improve on stated metrics, and grow the department as needed to meet the needs of the business.   

 

Duties and Responsibilities

 

• In coordination with the Referral Supervisors organize, direct, coordinate the operations of the referral department.
• Maintain ongoing tracking and appropriate documentation of referrals to promote team awareness and ensure patient safety.
• Standardize processes and procedures for continued referral compliance.
• Subject Matter expert for all things pertaining to centralized referral team.
• Coach and provide training for Referral Supervisors.
• Problem solving daily operation issues.
• Collaborate with other departments related to management of the Centralized Referral team to ensure quality and compliance for referrals.
• Select, orient, train, counsel, discipline, and direct staff.
• Assists Referral Supervisors in problem solving to move referrals to completion.
• Conduct and participate meetings.
• 1:1 meeting with direct reports
• Additional point of contact for providers and specialists for questions or rising concerns.
• Run referral reporting to analyze data, adjust processes as needed or improve on department KPIs.
• 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.
• Work to create and build a catalog for each market of preferred specialist offices for use by referral coordinators to ease coordination of care through the referral process.
• Ensure proper access and use of external Health Information Exchanges, which may be used for timely record retrieval, and/or electronic submission of specialist referrals.
• Maintain a general level of knowledge of appropriate triage of patient and physician needs.
• Trouble shooting and alerting the providers or management of coverage issues or barriers to scheduling requested specialist referrals.
• Maintain the security and privacy of all information that is owned by AbsoluteCare or maintained on behalf of the company’s patients, employees, and business partners.

Minimum Qualifications

 

• 5 + years’ experience with specialist referrals, medical records, insurance and benefit
• Bachelor’s degree required; 5 years relevant equivalent experience may be substituted for education.
• Minimum five (5) years Manager level experience of teams greater than ten (10) employees
• Experience working with Clinicians.
• Experience reviewing data and making decisions based of the data.
• 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.
• Experience working in EHRs (preferably eClinicalWorks).

 

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

Referral Supervisors, Clinical Support Specialist

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