POSITION SUMMARY:    Process Medical/Dental referrals and prior authorization requests. Interacts with internal and external customers to provide and obtain information and ensures the delivery of outstanding service and quality. Responsible for contacting patients and specialists to schedule specialty appointments; follows up with patient until completion of appointment; retrieves the specialist’s reports directly, scans the report into the EHR, and notifies the referring provider.  Performs a wide range of clerical support.

POSITION-SPECIFIC COMPETENCIES/ESSENTIAL FUNCTIONS/DUTIES & RESPONSIBILITIES

• Accurately processes Medical/Dental referrals and prior authorization request in accordance with insurance specifications.
• Verify insurance information with appropriate insurance carrier.
• Provides weekly and as needed updates to Provider regarding referral status, answers questions regarding patient referral appointments.
• Monitors internal and external referrals and referral sources using the organization’s EHR.
• Informs patients of our ancillary services, and schedules them with internal resources.
• Assists patient with navigating through various services available within the organization and schedules.
• Educate the patient on the policies concerning covered services and what to do in an emergency.
• Assist the patient in selecting a specialist in accordance with their insurance and referral.
• Offer assistance in arranging an initial medical/dental visit with the referred specialist and documents necessary information.
• Keep patients informed of progress of scheduled appointments and documents all patient contact in the EHR.
• Monitor of patients’ adherence to their medical/dental appointments.
• Performs outreach to assist the patient in completing the referred service and documents contact in the patient’s medical records. 
• Follows up with specialists to ensure that the organization receives the report for the referred service.
• Ensures that the report is scanned into the EHR and the referring provider is notified using the EHR.
• Conduct outreach activities for patients lost to care using organizational reports, and reports provided by various payers and ACO organizations.
• Prepares weekly/monthly departmental reports as needed and when requested.
• Determine appropriateness of referral requests from patients and consults with patients Provider.
• Provides input for the development and/or revision of departmental policies and procedures.
• Maintains compliance with departmental and other MHSI policies and procedures.
• Attend seminars, training sessions, and meetings to keep abreast of the changes related to job duties and department.
• Perform other job-related duties, as may be assigned.

• Excellent customer service skills- displayed by meeting or exceeding customer expectations by following up with patients and specialists to ensure timely completion of services.
   
• Resourcefulness- Develops and documents a network of contacts with referred specialty providers.  Knows who to contact within the organizations for various needs.
   
• Organization and planning skills-Plans, organizes, and completes tasks in an acceptable time frame-48-72 hour.
   
• Problem solving skills-successfully identifies, analyzes, and solves problems by approaching problems in a positive manner, and by identifying practical solutions. 
   
• Productivity and volume-Consistently meets or exceeds productivity targets, regularly completes work ahead of schedule.  Minimum productivity is 325 referrals per month with the primary focus on internal referrals and external pain management referrals. 

POSITION REQUIREMENTS

• Education:           Must have a High School Diploma or equivalent.
• Experience:          Background experience in insurance regulations, medical procedure/surgery scheduling, and medical triaging helpful, but not necessary.
• Expertise:            Knowledge of medical terminology helpful but not necessary. Knowledge and proficiency in Microsoft Office.  Requires excellent customer service and organizational skills.  Must exhibit ability to respect the individuality of others, and work effectively with a range of customers.  Must be a self-starter, willing to take initiative.     
• Language:            Comprehend and use basic language either written or spoken to communicate information and ideals.
• Hours of Work:     May vary based on Organizational need.
• Travel:                 May vary based on Organizational need.