Referral Coordinator

Arcadia is dedicated to happier, healthier days for all. We transform diverse data into a unified fabric for health. Our platform delivers actionable insights for our customers to advance care and research, drive strategic growth, and achieve financial success. For more information, visit arcadia.io.

Why This Role Is Important to Arcadia

In this position you will be working with a team of independent and autonomous Referral Coordinators within the Intake Department to break down barriers and ensure quality and timely care. In collaboration with your teammates, you will strive for continuous improvement and an excellent work-life balance to produce top-notch results.

What Success Looks Like

In 3 months

- Team member should be able to understand how to navigate referral episodes in the internal documentation system and be able to assist 20-30 customers per day with assistance

- Understanding their daily functions such as navigating the call queue, answering phone calls and assisting customers with entry-level questions

In 6 months

- Team member should feel very confident with their call queues and be able to assist 20-30 customers per day with accurate information provided

- Able to take on more responsibilities such as learning Claims and Eligibility basics and troubleshooting issues with complex cases

In 12 months

- Team member should be able to assist 20-30 customers accurately, have excellent knowledge of each department processes and guidelines, trouble shoot and help others in the department, confident in handling phone calls and providing the correct information to our clients

What You'll Be Doing

• Interpreting referral and pre-certifications complying with multiple sets of protocols which are built in the application
• Maintains and manages strict confidentiality of all information, whether received directly or indirectly as it relates to health care services
• Enter referral and pre-certification calls into software program accurately
• Answer phone calls as well as make phone calls
• Responsible for expediting calls to ensure accuracy and timeliness of referral and pre-certification authorizations
• Assists physician offices and providers with referral and pre-certification questions
• Works with Customer Service, Provider Relations and Claims staff to clarify or rectify discrepancies between referrals, pre-certifications and claims
• Adheres to all audit procedures
• Performs other duties as assigned

What You'll Bring

• Knowledge of medical terminology
• Preferred medical office experience
• One years' experience in managed care with referral interpretation
• Knowledge of medical coding; including ICD-10, HCPC's and CPT codes
• Able to adapt to different situations and multitask
• Must have ability to work independently, maintain organization and meet deadlines
• Highly skilled in verbal and written communication
• Able to problem solve, exercise initiative and make decisions
• Able to communicate clearly and work effectively with co-workers, management, physicians, members, vendors and customers

Would Love For You To Have

• Knowledge of Excel basic function and PDF Converter and/or Adobe Pro
• Positive disposition
• Hardworking
• Eager to learn
• Very dependable
• Works well with others

What You'll Get

• Flexible hours, working remote, collaborating with a great team!
• Be a part of a mission driven company that is transforming the healthcare industry by changing the way patients receive care
• A flexible, remote friendly company with personality and heart
• Employee driven programs and initiatives for personal and professional development
• Be a member of the Arcadian and Barkadian Community 

This position is responsible for following all Security policies and procedures in order to protect all PHI under Arcadia's custodianship as well as Arcadia Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

About Arcadia

Arcadia.io helps innovative healthcare systems and health plans around the country transform healthcare to reduce cost while improving patient health. We do this by aggregating massive amounts of clinical and claims data, applying algorithms to identify opportunities to provide better patient care, and making those opportunities actionable by physicians at the point of care in near-real time. We are passionate about helping our customers drive meaningful outcomes. We are growing fast and have emerged as the market leader in the highly competitive population health management software and value-based care services markets, and we have been recognized by industry analysts KLAS, IDC, Forrester and Chilmark for our leadership. For a better sense of our brand and products, please explore our website, our online resources, and our interactive Data Gallery.

This position is responsible for following all Security policies and procedures in order to protect all PHI under Arcadia's custodianship as well as Arcadia Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.