Referral Management Clerk - Healthcare

Federal Staffing Resources•San Antonio, TX

7d•Remote

About The Position

The Puget Sound Military Appointing Center (PSMAC) is a centralized services center that serves as the primary point of contact for PSMHS beneficiaries for PAS, RMS, and CLRS as they seek healthcare services, and is therefore a critically important resource in our healthcare delivery system. This role involves managing inbound and outbound calls from beneficiaries, validating eligibility, and scheduling, canceling, and rescheduling patient appointments to ensure timely access to quality healthcare. The position also includes making outbound calls to schedule specialty appointments for beneficiaries with direct care specialty referrals and processing Referral Management System (RMS) services to ensure timely scheduling of specialty care referrals ordered by MTF HCPs. This includes identifying referrals to be deferred to the network, ensuring processing in accordance with DHA timeliness, and tracking the status of network referrals. A key responsibility is reviewing MTF-generated referrals to determine if they should be 'Appoint to MTF' or 'Defer to Network (DTN)' based on specialty clinic capabilities, capacities, and DHA access to care standards, aiming to maximize specialty care retention within the MHS. Additional duties involve processing Secure Message Service (SMS) transmittal requests, drive-time mapping for specialty care appointing, and sending outbound letters to beneficiaries referred for MTF specialty care.

Requirements

High school diploma or General Educational Development (GED) equivalency
Skilled in Word, Excel, Access, and other software programs
Excellent communication, interpersonal and customer service skills
Able to define problems and obtain solutions
Must be able to obtain clearance to access the work site and be granted a Common Access Card (CAC).
Must be able to clearly communicate, verbally and written with coworkers and clinic staff.
Ability to obtain facility security
Must work remotely within the United States from an approved home address
Must be available and responsive during scheduled work hours
Dedicated, private workspace with a door required (no shared/common areas)
Must use company-issued or approved secure equipment only
Required to have wired (Ethernet) internet connection
Minimum internet speeds: Download: 50 Mbps

Nice To Haves

Healthcare administrative experience

Responsibilities

Disposition all routine referrals as either Appoint to MTF, Defer to Network, or route to MTF Referral Management Center (RMC) IAW standardized PSMHS business policy.
Document and report complaints received, errors found, and the specific corrective action taken by the contractor. Errors shall include those identified by patients/beneficiaries, clinic and/or MTF staff, and direct to the contractor.
Process incoming referrals (ROFR) from the MCSC network providers and MTFs according to eMSM, DHA requirements and standardized guidelines.
Record and track status and disposition on all Prime/Select/VA/ ROFRs, MTF, and network referrals and communications received, per DHA and PSMHS business rules.
Review all referrals and appoint to MTF referrals, or return to requester based on policies and procedures.
Provide Monthly Reporting.