Medical Referral Specialist Jobs

+-----------------------------------------------------------------------+ | Primary Purpose: | | | | The person in this position is a member of the Patient Centered | | Health Care Home team where each team member plays an integral role | | in providing patient-centered health care. S/he performs utilization | | management activities within the health center; monitors patient | | referral insurance paperwork to assure timely processing and accurate | | authorization of referrals to external agencies and/or consultants. | +-----------------------------------------------------------------------+ | Essential Duties: | | | | - Perform Utilization Management Functions: | | - Monitor patient insurance status to insure timely and | | accurate authorization of referrals for service and drug | | assistance. | | - Communicate by telephone and mail with clients regarding | | appropriate use of medical benefits as it pertains to | | existing referrals | | - Support physicians and their staff to accurately complete | | referral paperwork and drug assistance authorization. | | - Create and maintain computer and/or manual referral logs | | - Verify patient eligibility for insurance coverage, under some | | instances will authorize approval for referrals. (ie: as | | insurance plan guidelines permit). | | - Verify participation with various insurance plans to assure | | maximum reimbursement and most cost effective selection of | | referral services source. | | - Follows up on patient referrals by calling the specialists | | - Tracks open orders as necessary | | - Tracks specialists performance | | - Follow KPHC Administrative Guidelines to promote effective and | | efficient patient care. | | - Make thorough, accurate and timely documentation. | | - Answer phones within a reasonable amount of time and take | | accurate messages. | | - Maintain patient confidentiality. | | - Support cost containment effort. | | | | Regular and reliable on-site attendance is required. | +-----------------------------------------------------------------------+ | Other Duties: | | | | Perform other related task as directed. | | | | Observe safety and security procedures; determine appropriate actions | | beyond guidelines; report potentially unsafe conditions; use | | equipment and materials properly. | +-----------------------------------------------------------------------+ | Minimum Qualification Requirements: | | | | Skills/Knowledge: | | | | - Ability to add, su tracts, multiply, and divides in all units of | | measure, using whole numbers, common fractions, and decimals. | | - Ability to compute rate, ratio, and percent and to draw and | | interpret bar graphs. | | - Ability to apply common sense understanding to carry out | | instructions furnished in written, oral, or diagram form. | | - Ability to deal with problems involving several concrete | | variables in standardized situations | | | | Education: | | | | High School Diploma or GED required, Post-secondary education | | preferred. | | | | Formal training in Medical Terminology required. | | | | Certified or registered Medical Assistant preferred. | | | | Experience: | | | | Experience in clinical setting required (any capacity). | | | | Previous experience in utilization management preferred. | | | | Experience in CPT, ICD9 coding preferred. | | | | Kalihi-Palama Health Center is an equal opportunity employer that is | | committed to diversity, and values the ways in which we are | | different. All qualified applicants will receive consideration for | | employment without regard to race, color, religion, sex, sexual | | orientation, gender identity, national origin, disability, veteran | | status, or other characteristic protected by applicable law. | +-----------------------------------------------------------------------+

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