Insurance Referral Specialist

We’re unique. You should be, too.

We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Care Coordinator is a highly visible customer service and patient-focused role that works directly with our patient population and their families, insurance representatives and outside vendors, physicians, clinicians and other medical personnel in a dynamic and professional environment to provide the highest level of quality healthcare to our members.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Coordinates and processes patient referrals to completion with precision, detail and accuracy.

Definition of completion:

• Prioritizes HPP patients in Primary Care Physicians panel, stats, expedites and orders over 5 days.

• Orders have been approved (when needed).

• Schedules patient (Preferred Providers List of Specialist) and notifies them of appointment information, including, date, time, location, etc.

• Uses Web IVR to generate authorizations (Availity, Careplus, Healthhelp NIA and any other approved web IVR for authorization processing).

• Completes orders with proper documentation on where patient is scheduled and how patient was notified.

• Referrals have been sent to specialist office & confirmed receipt.

• Prepares and actively participates during physician/clinician daily huddles utilizing RITS Huddle Portal and huddle guide. Communicates effectively the physicians/clinicians needs or outstanding items regarding to patients. 

• Enters all Inpatient and Outpatient elective procedures in HITS tool.

• Ensures patient's external missed appointment are rescheduled and communicated to the physician/clinician.

• Participates in Super Huddle and provides updates on high priority patients referrals.

• Addresses referral based phone calls for Primary Care Physicians panel.

• Completes and addresses phone messages within 24 hours of call.

• Checks out patients based on their assigned physician/clinician. (Note: If assigned Care Coordinator is unavailable at the time of check out, a colleague shall assist patient. This process does not apply to Care Specialist) 

• Retrieves consultation notes from the consult tracking tool.

• Follows up on all Home Health and DME orders to ensure patient receives services ordered.

• Provide extraordinary customer service to all internal and external customers (including patients and other

• ChenMed Medical team members) at all times. Utilization of patient messaging tools.

• Performs other related duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Must be detail-oriented, possess the ability to multi-task and be open to cross-functionally training in referrals duties.

• The individual in this role must exercise proper phone etiquette and have the ability to navigate proficiently through computer software systems.

• Must be team-oriented and work extremely well with patients, colleagues, physicians and other personnel in a professional and courteous manner.

• Exceptional organizational skills with the ability to effectively prioritize and timely complete tasks. Knowledge of medical terminology, CPT, HCPCS and ICD coding preferred.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of medical terminology, CPT, HCPCS and ICD coding desired

• An understanding of the company's patient population, including the complexities of Medicare programs

• Exceptional organizational skills with the ability to effectively prioritize and complete tasks in a timely manner.

• An understanding of the company's patient population, including the complexities of Medicare programs

• Detail-oriented with the ability to multi-task.

• Able to exercise proper phone etiquette.

• Ability to navigate proficiently through computer software systems & use technology.

• Ability to work well with patients, colleagues, physicians and other personnel in a professional manner.

• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, database, and presentation software.

• Spoken and written fluency in English; bilingual preferred.

EDUCATION AND EXPERIENCE CRITERIA:

• High School diploma or equivalent required

• A minimum of 1 year of referral experience in a healthcare setting required.

• Experience with web-based insurance sites and obtaining referrals/authorizations for multiple payors preferred.

• Experience with Web IVRs and obtaining referrals/authorizations for multiple payers strongly preferred

• Healthcare experience within the Medicare Advantage population preferred.

• Medical Assistant certification preferred

• CPR for Healthcare Providers is preferred