Coordinator, Qualification III

Position:  Qualification Coordinator III

Department: Referral Management

Reports to:  Referral Management Manager

Position Description:

The Qualification Coordinator III is responsible for accurately processing all assigned referrals. The Qualification Coordinator III acts as a liaison to facilitate communication between referral sources, patients, and the health care agencies. The Qualification Coordinator III maintains accurate records in compliance with applicable laws and regulations and the policies of tango.

Office Location:

• Office located at 7600 North 16^th Street, Suite 140 Phoenix, AZ 85020 (Remote)

Responsibilities and Duties:

• Responsibilities of the Qualification Coordinator III include, but are not limited to the following:
• Receive referrals and enter all applicable information regarding the patient referrals into referral management system including but not limited to: patient demographics, contact information, disciplines requested and all necessary medical information to affirm appropriate patient care
• Ensure all attached documents are HIPAA compliant for each referral processed.
• Identify and process expedited requests immediately and communicate the priority status to all appropriate internal teams.
• Verify insurance eligibility for each patient through software automation, running insurance manually through payor websites when needed.
• Contact appropriate parties (patient and/or referral source) of prior authorization decisions; including but not limited to approvals, requests for more information or not able to process due to insurance.
• Call agencies to coordinate continuance of patient services.
• Ensure service requests include all required documentation and that services approved are appropriate based on documentation provided.
• Contact patients and referral sources to obtain any additional information needed and inform of referral processing outcomes.
• Identify and escalate referrals for medical review to the clinical team and follow through on the resolution of each referral.
• Upon approval of referrals, apply the appropriate visits/disciplines to the patient referral per the patient’s demographic area.
• Properly document patient records with the use of notes within the Tempo system and maintain required logs.
• Accurately follow up on patient referrals as needed.
• Adhere to all company policies and procedures
• Adhere to performance expectations

Qualifications:

• Must be at least 18 years of age.
• High School Diploma or GED, some college
• Medical Assistant or CNA with at least 2 years of experience working in a Medical Facility.
• Has extensive knowledge and experience including but not limited to: Microsoft Word, Microsoft Excel, Adobe PDF, and ability to navigate computer systems efficiently.
• Typing speeds >60 WPM with >95% Accuracy.
• Reading speeds >250 WPM with >90% Comprehension.
• Must be flexible and willing to work weekends and Holidays.
• Detail oriented and displays good organizational skills.
• Must be able to sit for long periods in front of computer.
• Must have reliable internet service

Proven Personal Attributes:

• Manage and prioritize multiple tasks effectively and efficiently while working home health referrals.
• Able to apply critical thinking skills to review referrals and determine if they meet the medical necessity criteria.
• Demonstrate empathy and compassion when communicating with patients regarding authorization decisions.
• Proactive in identifying and resolving any issues or challenges that may arise during the referral management process.
• Self-directed, flexible, cooperative, and exhibits the ability to work with minimal supervision.
• Capable of following an issue through to its conclusion.
• Maintain a growth mindset on improving knowledge in referral management practices.
• Able to remain calm under pressure and manage stressful situations.
• Provide excellent and professional customer service skills with a positive, patient, and friendly attitude.
• Able to establish highly productive and detailed organizational skills/habits.
• Possess strong, professional written and oral communication skills for in-person, telephonic, and electronic use.

tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.