Employment Type : Full-Time
Overview
HonorHealth is a non-profit, local community healthcare system serving an area of 1.6 million people in the greater Phoenix area. The network encompasses six acute-care hospitals, an extensive medical group, outpatient surgery centers, a cancer care network, clinical research, medical education, a foundation and community services with approximately 12,300 employees, 3,700 affiliated physicians and 3,100 volunteers.
Neighborhood Outreach Access to Health (NOAH) is looking for talented healthcare team members to step into our culturally diverse health centers! NOAH is a federally qualified healthcare center (section 330 grantee) that provides affordable, high-quality outpatient healthcare services to Maricopa County. Our integrated model of care places patients’ needs at the center of attention as we deliver comprehensive health services including medical, dental, psychiatry, counseling, nutrition, prenatal care, preventive health, eligibility assistance and health education programs. With 9 healthcare centers throughout Maricopa County, we are a premier source for high quality healthcare.
HonorHealth was formed by a merger between Scottsdale Healthcare and John C. Lincoln Health Network. HonorHealth’s mission is to improve the health and well-being of those we serve.
Responsibilities
Job Summary
The Referral Specialist at NOAH is responsible for serving as a specialist in the coordination of all aspects of specialty referrals incoming and outgoing, eligibility verification, and maintenance for practice patients. This responsibility includes obtaining client information, maintaining patient files, verifying information with appropriate agencies, and reporting statistics and data as required. Obtaining referral and prior authorizations, assist providers, staff, and patients with referral questions. Process referrals and sending eligibility information for NOAH's sliding fee scale patients. Verification of coverage and correct documentation within the patient medical record to complete the referral process thoroughly within the EHR system. Referral Specialist will complete internal behavioral health and nutrition referrals according to their benefits. Referral Specialist will ensure process is completed accurately through each work queue to adhere to all governing federal regulations, including FTCA deeming requirements associated with the NOAH program.
Serves as a specialist in processing and approving selected specialists referrals according to policy and procedure established by the Network in general and PN specifically.
Obtains referral request documentation
Maintain ongoing tracking and appropriate documentation on referrals within the three work queues that are assigned and closing the loop.
This tracking is done through an EMR system along with an ICP system.
Demonstrates a high degree of accuracy and timeliness in completing referral authorizations/prior authorizations
Compiles all pertinent medical data and supporting documentation and faxes or mails to appropriate receiver.
Verifies eligibility, benefits and contractual appropriateness.
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 and resolves the status of problem authorizations
Assemble information concerning patient's clinical background and referral needs. Per referral guidelines through their specific insurance plan, provide appropriate clinical information to specialist.
Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis and prognosis.
Ensure 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 to assure follow-up.
Ensure that patient's primary care chart is up to date with information on specialist consults related to their health.
Review details and expectations about the referral with patients.
Responsible for training and orientation of new Referral Coordinator’s into practice.
Trains new Referral Coordinator employees on correct 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.
Obtains information to be entered from multiple sources such as providers, nurses, etc.
Logs, tracks, and resolves issues within specific timeframe to ensure accuracy and timeliness of data entry.
Brings errors and/or issues to the attention of designee.
Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.
Navigates through multiple complex EMR screens and enters data.
Remind patients of scheduled appointments via EMR system, by mail, or by phone.
Performs other duties as assigned.
Qualifications
Education
High School Diploma or GED Required
Experience
1 year Related/referral experience Required
Licenses and Certifications
Fingerprint Clearance Card - State Have a current Fingerprint Clearance card, or within seven (7) working days after employment shall apply and be eligible for a Fingerprint Clearance Card (NOAH Clinical Sites and Pediatric Behavioral Health Sites ONLY) Required