Medical Referral Coordinator

Department: Health & Human Services

Reports to: Joanne Perry, Operations Manager

FLSA Status: Non Exempt

TS Range: 5/6 ($21.48)

Closing Date:January 26, 2024

POSITION SUMMARY:

The Medical Referral Coordinator manages all medical and behavioral health referrals. This position coordinates with the referring provider to submit referrals to other providers and/or insurance companies. This position also works with patient registration, support specialist and purchase referred care for the clinic as well as helping patients gain or maintain insurance coverage.

RESPONSIBILITIES:

· Facilitates administrative components of clinic referrals (documentation, forms, communications)

· Ensures patients are sent to in-network specialty care for their respective medical coverage.

· Ensures that required documentation for referral is complete and all pre-certification or authorizations are submitted and approved.

· Serves as a tribal assister to help patients apply for medical insurance and other services

· Acts as a liaison between providers, hospitals, health plans, vendors, case managers, patients/families, and other support services

· Informs patients of possible copays, deductibles, and other out-of-pocket fees they may be liable for when completing referrals

· Verifies insurance coverage.

· Documents all cases in the electronic health record

· Works with PRC Specialist (and/or board) to determine eligibility for beneficiary services

· Works with Medical Records Technician for accurate coding for documentation

· Coordinates with Support Services Specialist for support needs including transportation for patients to complete services

· Transfers cases to Support Services Specialist for follow up once approved and scheduled

· Assists patients and clinic with Quest Diagnostics fees

· Will cross-train in other administrative staff positions for backup purposes

· Other duties as needed.

SUPERVISORY RESPONSIBILITIES:

None

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

· Demonstrated professional ethics and integrity;

· Protects all aspects of client information and maintains professional boundaries;

· Maintain confidentiality by following all applicable HIPAA regulations;

· Excellent oral and written communication skills;

· Ability to work cooperatively with Tribal community;

· Ability to forge productive relationships with consultants and external partners;

· Proficient in the use of the computer, Microsoft Word, Excel;

· Collect data accurately and in a timely manner;

· Experience working in a Tribal or Urban Indian health facility preferred.

LANGUAGE SKILLS:

Ability to read, analyze, and interpret common technical manuals and patient records. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the community. Ability to effectively present information to top management, co-workers, and public groups.

MATHEMATICAL SKILLS:

Ability to understand with mathematical concepts such statistics. Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations. Basic accounting skills.

REASONING ABILITY:

Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several concrete variables. Must have the ability to work with and relate to individuals from various socio-economic backgrounds. Must understand the ethical implications and patient confidentiality issues involved in this line of work, particularly in a small community. Must understand and accept their relationship and boundaries with patients and other staff members.

CERTIFICATES, LICENSES, REGISTRATIONS:

Must successfully pass a background check.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear; the employee is frequently required to stand, walk, sit, use hands to finger, handle, or feel and reach with hands and arms. The employee is occasionally required to climb or balance, stoop, kneel, crouch or crawl and taste or smell. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required for this job include close vision, distance vision and peripheral vision.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level is the work environment is usually moderate.

CONFIDENTIALITY:

Must maintain the utmost strict confidentiality in all work, cases and files pertaining to projects and activities of this position. Any violation of this matter will result in termination of employment.

DRUG FREE WORKPLACE:

The successful candidate will be required to have a urinalysis for drug and alcohol screening in accordance with the Tribe’s Drug Free Workplace Policy.

INDIAN PREFERENCE:

Indian Preference will be exercised in the hiring of this position in accordance with the Tribe’s Personnel Policies.

TOAPPLY: Submit application packets including a resume and cover letter to apply@squaxin.us Contact Human Resources for more information: 360-432-3865.

EDUCATION and/or EXPERIENCE:

Associate of Arts Degree and one year of health care related experience, OR High School Diploma/GED and three years’ experience in healthcare or clerical experience OR five years of healthcare or clerical experience.

Course in medical terminology preferred.

Experience entering data in electronic health record.

This position also requires typing ability of 40 words per minute.