(TEMP) Referral Peer Coordinator - Community Psychiatry - MSM - Full Time/Days

Mount Sinai Health System•New York, NY

About The Position

Handles referrals for patients in the department and contact outside agencies to set up the specifics of how referrals are processed, tracked and returned.

Requirements

High School graduate or GED

Responsibilities

Meets regularly with the managed care provider relations staff to resolve managed care insurance issues and discuss new trends in managed care
Educates all new clerical employees about the managed care process
Maintains an active patient database on the number of visits and expiration dates of all referrals
Receives a copy from the clinic of every referral with the patient visit
Reconciles the database with the referral
Reviews on a daily basis the clinic report to determine the clinic visits that require a referral and checks to see that a referral was obtained by the registrar
Obtains a copy of the visit of patients who were referred externally and send copy of visit to the provider
Downloads monthly the patient roster from the managed care sites and gives a copy to the clinic so staff can determine patients who need referrals
Generates a referral for those managed care patients listed on the roster who present to the clinic without one
Sends a copy of all Center Care referrals to finance for distribution to Center Care
Retains a copy of all referrals on file for one year
Reviews all bills rejected by managed care companies
Determines the cause of the rejection and provides the company with the information they need to expedite payment to the hospital
Resolves all referrals issues that occur on day of visit
Assists managed care patients who have inquires relative to the specifics of their plan, who want to change their PCP etc.
Acts as the resource for staff on managed care issues and responds and resolves problems that arise
Stays in constant contact with patients educating them on the logistics of their managed care plan
Communicates with managed care companies not contracted by the hospital, to obtain authorization to treat their patients who present to the clinic or to determine the patient’s PCP and provide that information to the patient