What are the responsibilities and job description for the Referrals Coordinator (PS) position at Desert Oasis Healthcare?
Processes Prior Authorization-Referral requests that are received from PCPs and-or Specialty Providers, handles incoming telephone calls and, routinely interacts with physicians and their office staff.
- Understands and follows Utilization Management Policies and Procedures pertaining to the referral process.
- Responds to all incoming calls and/or follows up calls in a timely manner. Performs the necessary research for determining a satisfactory disposition. Voice mail is checked promptly after breaks and lunches.
- Works with the Membership Management and Health Plan Benefits Departments on an as needed basis.
- Documents all applicable notes, reminders, date/time stamps, initials etc involved with the referral process.
- Accepts calls from physicians and/or their office staff, as well as health plan inquiries regarding referral status. When needed, performs the necessary research (i.e., tracks down the referral packet, etc.).
- Is able to achieve and maintain all applicable departmental production standards and goals.
- When time permits, all staff are expected to assist others within the department to facilitate work flow and the referral process.
- Verifies that the patient address in Ez-cap corresponds with prior authorization/referral request form.
- Recognizes health plan types and makes notation of any/all shared risk or other unique payors or providers as directed.
- Recognizes all referral types as well as level of urgency and performs accurate data entry within productivity standards.
- Perform other duties as assigned.
- High school diploma or equivalent required.
- Two years current experience in a medical office or health plan environment.
- Current knowledge of medical coding and medical terminology.
- Strong computer skills and proficiency in word processing.
- Detail oriented, able to function under pressure and perform multi-tasks at any given time.
- Excellent communication skills, verbal and written.
- At the discretion of DOHC/FHC management, this position has the potential to be a full or hybrid telecommuting position.
