What are the responsibilities and job description for the Referrals Navigator position at MaineGeneral Health?
Job Summary
Navigates the healthcare referral process with patients supporting them in getting their individual healthcare needs met with the right service at the right time. This is done by processing referrals based on referral information obtained and medical staff driven algorithms. It also includes ensuring completed insurance authorizations are received using appropriate methods provided by insurance companies.
Job Description
Navigate multiple department-specific referral algorithms in order to ensure patients receive the right service at the right time. This can include work with other department leadership and medical staff to ensure schedule utilization and efficiency. It can also include verifying that documentation is complete for the service the patient received as an outcome of the referral processed.
Act as a liaison between referral sources, patients and medical staff to ensure patients receive the right service at the right time. This includes making sure referrals have been processed correctly and include all necessary information required by medical staff including, but not limited to, imaging, medical records and any diagnostic testing. Documents/updates records to verify all parties have accurate information.
Process necessary referral authorizations and pre-certifications correctly by working closely with clinical/administrative staff, patients, and payers. Initiate authorization requests in accordance with the prior authorization list and other laws/regulations by applying knowledge of medical terminology and the insurance environment.
Collect data on all referral processes, and works with leadership to analyze this data for improvements in patient experience, access and other efficiencies.
Scheduled Weekly Hours
40
Scheduled Work Shift
Job Exempt
No
Benefits
Supporting all aspects of our employees' wellness - physical, emotional and financial - is a critical component of being a great place to work. With the wide range of benefits and programs available, employees have the resources they need to be well at every stage of life and plan for the future.
Physical Wellness
When life gets challenging, employees have access to our Employee Assistance Program for employees and anyone in their household.
Financial Wellness
Helping our employees develop their skills and grow their careers is critical to how we retain our talent and sustain our business. We do this by offering our teammates a variety of leadership-supported programs and learning and development resources for every stage of their professional development. We know that our employees are our most valuable resource - they're how we grow our business and care for our community.
Equal Opportunity Employer M/F/Vet/Disability Assistive technologies are available. Application assistance for those requesting reasonable accommodation to the career site is available by contacting HR at (207) 861-3440 .
Navigates the healthcare referral process with patients supporting them in getting their individual healthcare needs met with the right service at the right time. This is done by processing referrals based on referral information obtained and medical staff driven algorithms. It also includes ensuring completed insurance authorizations are received using appropriate methods provided by insurance companies.
Job Description
Navigate multiple department-specific referral algorithms in order to ensure patients receive the right service at the right time. This can include work with other department leadership and medical staff to ensure schedule utilization and efficiency. It can also include verifying that documentation is complete for the service the patient received as an outcome of the referral processed.
Act as a liaison between referral sources, patients and medical staff to ensure patients receive the right service at the right time. This includes making sure referrals have been processed correctly and include all necessary information required by medical staff including, but not limited to, imaging, medical records and any diagnostic testing. Documents/updates records to verify all parties have accurate information.
Process necessary referral authorizations and pre-certifications correctly by working closely with clinical/administrative staff, patients, and payers. Initiate authorization requests in accordance with the prior authorization list and other laws/regulations by applying knowledge of medical terminology and the insurance environment.
Collect data on all referral processes, and works with leadership to analyze this data for improvements in patient experience, access and other efficiencies.
Scheduled Weekly Hours
40
Scheduled Work Shift
Job Exempt
No
Benefits
Supporting all aspects of our employees' wellness - physical, emotional and financial - is a critical component of being a great place to work. With the wide range of benefits and programs available, employees have the resources they need to be well at every stage of life and plan for the future.
Physical Wellness
- We offer quality health, dental, and vision benefits and wellness programs and resources to provide employees access to resources for a healthy lifestyle and help manage health care costs.
- Employees have access to industry-leading leave for new parents.
- A generous earned time plan is offered to all employees - We believe employees need and deserve time away from work to observe holidays, be with family, go on vacation, or simply take care of themselves.
When life gets challenging, employees have access to our Employee Assistance Program for employees and anyone in their household.
Financial Wellness
- An employee discount program is available to all employees for services provided by MaineGeneral Medical Center.
- Tuition Reimbursement is available to all employees to further develop skills and career.
- We offer eligible employees up to 2% of eligible pay in 403(b) company-matching contributions plus another 2% in the 401(a) retirement income plan.
- Three insurance plans are available to protect your family from the sudden loss of income in the event of your death, terminal illness or serious injury from accident.
- We offer both short-term and long-term disability insurance to replace a portion of your income if you become disabled and cannot work for a period of time.
Helping our employees develop their skills and grow their careers is critical to how we retain our talent and sustain our business. We do this by offering our teammates a variety of leadership-supported programs and learning and development resources for every stage of their professional development. We know that our employees are our most valuable resource - they're how we grow our business and care for our community.
Equal Opportunity Employer M/F/Vet/Disability Assistive technologies are available. Application assistance for those requesting reasonable accommodation to the career site is available by contacting HR at (207) 861-3440 .
