What are the responsibilities and job description for the Referrals Manager position at Gonzaba Medical Group?
Job Details
Referrals Manager
General Summary: The Referrals Manager will have administrative responsibilities such as hiring, performance management, and collaborating with staff to ensure referral procedures are followed properly. This position will require a continuous process improvement to ensure all standards of compliance are maintained.
Supervisory Responsibilities: Supervises assigned staff. Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
General Requirements: All duties performed will be done accurately and in a timely manner.
- Ensures team is meeting goals and objectives through effective hiring, training, performance management, coaching, counseling, and retention efforts.
- Develops and implements standardized workflows.
- Prepares statistical data reports for senior management.
- Identifies key performance metrics related to referral network utilization in alignment with desired program outcomes and communicates, educates, and holds the team accountable for outcomes.
- Develops and implements the review process using MCG criteria to ensure compliance.
- Collaborates with other departments regarding opportunities for improvement.
- Provides expertise and assistance in assigned areas.
- Maintains professional affiliations and enhances professional growth and development to keep current in the latest trends in collections management.
- Other duties as assigned.
- Maintains strictest member and company confidentiality.
Essential Job Responsibilities:
- Leads the referral department in coordinating referrals from physicians to hospitals and specialists.
- Receives inquiries from providers, patients, HMOs, and addresses requests in a timely manner.
- Participates in all referral and UM audits with our delegated health plans. Collaborates with the team to resolve opportunities from each audit to attain compliance with specific standards and processes.
- Establishes special and/or ongoing projects including assignment of personnel, project goals, and time frames for division.
- Develops and implements policies and procedures for the referrals department.
- Runs reports to interpret, analyze, evaluate, and measure audit performance of the referral department to identify opportunities to increase productivity and accuracy.
- Ensures complex referral requests for nurses, physicians, or committee review are routinely completed, verifying eligibility, chart availability, and conducting benefit research.
- Participates regularly in committees such as PCC, Claims, and Manager meetings.
Education and Training: Minimum high school education or equivalent required. BA/BS, MA or extensive related experience preferred. Previous experience with referral management workflows, systems and leading a centralized referral center for 2-5 years required. Supervisory experience of 3-5 years is required. Knowledge of Managed Care principles highly preferred. Must be able to communicate effectively in both written and verbal forms. Previous experience in managed care referrals. Must have knowledge of ICD-10 and CPT-4 coding, and medical terminology.
Other Requirements: Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.
Work Environment: Depending upon the area assigned, may be 100% clinical setting, office setting in a clinical environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.
Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 10 lbs. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.
Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.
Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.
