Referral Operations Manager

North Shore Community Health•Salem, MA

1d•Hybrid

About The Position

Under the direction of the Vice President of Operations, the Referral Operations Manager will be responsible for overseeing referral processes and ensuring accurate insurance verification and eligibility for patients ahead of their visit. The Manager will ensure referrals are processed, tracked, and completed in a timely manner, while collaborating with leadership to address challenges in care coordination and insurance verification. This role includes building new referral networks, optimizing workflows, and maintaining strong relationships with referral partners. Additionally, you will track key performance indicators (KPIs), lead special projects, and ensure compliance with accreditation standards. The Manager will also provide coaching, support team development, and step in to assist with daily tasks when needed.

Requirements

High School Diploma required.
Minimum of three (3) years of experience in a healthcare setting.
Minimum of five (5) years of customer service experience, preferably in a healthcare setting.
Demonstrated leadership experience with the ability to multitask effectively.
Prior supervisory experience preferred.
Experience with Medicare, Medicaid, and managed healthcare.
Strong organizational and communication skills.
Ability to work effectively in a culturally diverse environment.
Team-oriented with a collaborative approach.
Detail-oriented with strong problem-solving skills.
Respectful and able to maintain patient confidentiality

Nice To Haves

English/Spanish bilingual ability preferred.

Responsibilities

Manages the work of the Referral Coordinators – including ensuring that appointments are verified appropriately, referrals are appropriately processed and tracked, and new patients assigned via Community Care Cooperative (C3) are scheduled in a timely manner.
Tracks data relating to common outgoing referrals and works to optimize processes around care coordination, patient education, scheduling, tracking, and loop closure
In partnership with Operational Leadership, works to identify common issues related to insurance verification and eligibility and develop strategies to mitigate these issues to improve referrals
In partnership with clinical leadership, identifies gaps in referral networks and connects to new partners in the North Shore region and beyond to establish new referral pathways
Maintains relationships with referral partners, providing feedback when necessary to ensure timely, high-quality care for North Shore patients.
With support from the Vice President of Operations, leads implementation for special projects (short or long-term), initiatives, and tasks as assigned.
Communicates to staff regarding changes to verification- and referral-related workflows and participates in ongoing clinical training as it relates to referral ordering.
Identifies and monitors key performance indicators (KPIs) that relate to the success of the referrals department.
Ensures Referral Team staffing levels and skill levels are maintained throughout operational hours
Provide coaching to Referral Coordinators to ensure technical knowledge and expertise are maintained and developed.
Support the Referral Coordinators to ensure they have the right tools to provide optimal performance and that all processes and protocols are followed appropriately
Monitor staff performance, provide day-to-day supervision of staff, including training, coaching, time and attendance, etc., and provide support in escalated calls and priorities
Oversee referral tracking procedures to ensure that all referrals that are tracked are managed within an appropriate time
Carry out functions associated with Referral Coordinator role as needed
Monitor, sort, and address incoming faxes to NSCH’s referral fax line as well as letter mail received at our administrative site
Leads onboarding of new Referral Coordinators
Own competencies named by accreditation bodies (e.g. NCQA) related to referrals and maintain compliance
Ensure that the Electronic Health Record has the most up-to-date information regarding specialists in our area of care
Maintain appropriate documentation on the referrals to promote team awareness and efficiency with the referral tracking
Communicate professionally with all individuals associated with the referral process, both internally and externally