Responsibilities:
Position Summary
The Details
- First point of escalation for all case related issues requiring guidance
- Responsible for daily completion of assigned patient referrals, while meeting production requirements
- Reviews, processes and supports Specialist referral requests by Concentra sites as defined by the market
- Obtains authorization for Specialist referrals and schedules appointments accordingly
- Ensures that appropriate networks and Concentra Advanced Specialists are used when applicable
- Provides all necessary information such as medical records, prescriptions, etc. to payor
- Communicates with stakeholders, payor, employer, and patient as appropriate
- Records all appropriate information via OA/CR module of OccuSource per Concentra policy
- Builds relationships with provider, employer and payor communities
- Identifies trends or patterns in missed capture and opportunities to gain capture; communicates these ideas and trends to Lead and Supervisor
- Handles calls according to the call guidelines of the department
- Participates in quality assurance processes including but not limited to the audit program, case reviews and training sessions
- This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Qualifications:
Education/Credentials
- High school diploma or GED equivalent
- Associated Degree from an accredited college preferred
Job-Related Experience
- Customarily at least one year of demonstrated experience in medical environment - service delivery (referrals, claims, insurance, billing, etc.)
- Experience with Worker's Compensation preferred
- Proficiency with scheduling/insurance verification software
Job-Related Skills/Competencies
- Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility
- The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies
- Familiarity with Microsoft Excel, Outlook, Word
- Excellent communication skills and ability to communicate (both written and orally) effectively with colleagues at all levels of the organization
- Must display proper business etiquette and be skilled in the arts of diplomacy and tact
- Excellent time management skills including the ability to multitask and prioritize in a fast-paced environment
- Ability to build and maintain productive business relationships
- Exemplary ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions
- Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism
- Excellent writing and documentation skills
- Strong attention to detail
- Ability to work independently
- Ability to handle special projects
- Ability to handle multiple tasks, projects, duties, and priorities, when assigned
- 401(k) with Employer Match
- Medical/Vision/Prescription/Dental Plans
- Life Insurance/Disability
- Paid Time Off
- Colleague Referral Bonus Program