The Medical Referral Coordinator role coordinates the physician's referral process of MDVIP members to the selected Medical Centers of Excellence (MCE) facility. The coordinator facilitates communication, compiles necessary documentation, and communicates with the MDVIP affiliated physicians, other specialists, MCE facility liaison, and MDVIP member to ensure a successful referral process by coordinating final reports back to the MDVIP affiliated physician. This position reports within the Insurance Services team, and may include administrative support, as needed, to ensure quality and compliance measures are maintained.
The successful candidate is one who is precise, methodical, and is able to perform repetitive tasks with a strict attention to detail, while achieving quality work on a consistent basis. The role requires someone who is confident in their communication skills and ability to be on the telephone the bulk of the day, dealing with sensitive medical issues. Able to maintain confidentiality and follow all work processes consistently.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Medical Centers of Excellence Activities
1.Gathers, reviews, and saves medical records, demographics, and any other pertinent/essential information electronically to initiate, resume, or research the MCE referral or request.
2.Organizes all pertinent data/materials to forward to the appropriate MCE Facility contact and verifies receipt.
3.Submits referrals and documentation to designated MCE facilities adhering to HIPAA and privacy regulations. Completes follow up within the specified timeframe in accordance with the MCE process guidelines.
4.Prioritizes work to ensure timeliness of referrals as related to appointments being scheduled, information needed from or to the facility is received, and any other extenuating circumstance that may be presented.
5.Initiates telephone contact with all parties to advise that a referral or request has been received and/or submitted. Provides the member with a thorough explanation of the referral process, as well as the selected facilities' process. Coordinates and/or assists with providing travel assistance information.
6.Confirms appointment dates and times prior to the appointment with both the member and the affiliated physician or office, as well as confirms with the member if any additional assistance is needed.
7.Following the member's appointment contacts the member to inquire about their experience and requests completion of a satisfaction survey.
8.Works collaboratively with the team to assist with additional referrals, surveys, or correspondence to guarantee success of the MCE team and provide exceptional service to our members.
9.Maintains accurate documentation updating and notating the MCE database and EMR systems to reflect accurate and true data integrity
10. Coordinates and schedules teleconferences, as needed, between MCE specialty physician and MDVIP physicians.
11. Manages chart reviews with MCE specialty physician as requested by MDVIP physicians. Ensures medical recommendations or reports are forwarded to the MDVIP physicians in a timely matter.
12. Forwards all research requests from MDVIP affiliated physicians to the MCE Manager according to department protocol.
1.Drafts and prepares correspondence to be reviewed and approved.
2.Prepares / mails approved correspondence to members, insurance companies, diagnostic centersl.
3.Answers telephones, faxes and scans documents, assists with reception duties, as needed.
4.Prepares and updates appropriate reports or presentations as needed.
5.Files and maintains electronic filing system.
6.Maintains data integrity by notating appropriate application systems and following through on tasks.
Associate's degree (A. A.) from two-year College or university and 3 years related experience and/or training; or equivalent combination of education and experience where two years of related experience equals one year of schooling.
Specific knowledge of medical terminology, insurance products, and health care coverage is needed. Knowledge of medical conditions, and a familiarity with the referral process, is preferred.
Advanced knowledge of Microsoft applications including: Word, Excel, PowerPoint, Publisher, Outlook, MapPoint, document storage systems, as well as, Internet Explorer and Adobe Software.
Able to learn new software easily. Net Docs and Salesforce.com experience preferred.
Ability to type 45 words accurately per minute.