Employment Type:

Full time

Shift:

Day Shift

Description:

At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.

The Referral Coordinators within SAMG is responsible for serving as a specialist in the coordination of all aspects of specialty referrals; both incoming and outgoing, eligibility verification, and maintenance for outpatient clinic patients. This responsibility includes obtaining client information, maintaining patient files, verifying information with appropriate agencies, and reporting statistics and data as required.  Obtaining referrals while assisting providers, staff, and patients with referral related questions.  Verification of coverage and correct documentation within the patient medical record to complete the referral process thoroughly within the EMR system.  Referral Coordinator will complete internal SAMG referrals according to the patient’s benefits.  Referral Coordinator will ensure process is completed accurately through each work queue to adhere to all governing federal regulations and SAMG policies.

POSITION DETAILS: This Full-Time position will support the team of providers for Boise/Nampa/Ontario Pulmonary Clinics and will work a Monday - Friday schedule. Primary responsibilities will be supporting new patients, VA, and Medicare/Medicaid.

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

• High school diploma or equivalent, Associate degree preferred

• 1 year of healthcare related referral experience required, 3 years preferred

ESSENTIAL FUNCTIONS:

• Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions.

• Serves as a specialist in processing and approving selected specialists referrals according to policy and procedure established by the Network in general and SAMG specifically. 

• Obtains referral request documentation.

• Maintains ongoing tracking through an EMR system and appropriate documentation on referrals within the three work queues that are assigned and closing the loop.

• Demonstrates a high degree of accuracy and timeliness in completing referral authorizations.

• Compiles all pertinent medical data and supporting documentation and faxes or mails to appropriate receiver.  Directly communicates with referring provider offices to request missing documentation and/or updates regarding delays in contacting the patient.

• Verifies eligibility, benefits and contractual appropriateness. Verifies all documentation is received from referring provider office.

• Acts as liaison between practice, patients, referral sources, and health insurance companies to resolve complaints and problems.

• Serves as expert internal consultant to all levels of practice staff.

• Monitors, resolves and updates the status of problem authorizations.

• Assembles information concerning patient's clinical background and referral needs. Per referral guidelines through their specific insurance plan, provide appropriate clinical information to specialist. Schedules diagnostic tests (if necessary) prescribed by Specialist provider to be completed prior to New Patient Appointment.

• Contacts review organizations and insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis and prognosis.

• Ensures that referrals are addressed within a timely manner. 

• Responsible for recording information within referral in order to assist in the tracking of referral and to assist and   ensure follow-up.

• Ensures that patient's primary care chart is up to date with information on specialist consults related to their health.

• Reviews details and expectations about the referral with patients.

• Responsible for training and orientation of new Referral Coordinator’s into practice.

• Trains new Referral Coordinator colleagues on current policies and procedures as needed.

• Continually maintains Health Insurance Portability and Accountability Act (HIPAA) and other compliance requirements.

• Enters non-clinical information into patient electronic medical record (EMR system).  Ensures all required information is keyed in thoroughly and accurately.

• Views non-clinical information in EMR system.

• Independently formulates information to be entered into EMR.

• Obtain