Referral Specialist- Care Coordination

Carle Health•Peoria, IL

2h•$19 - $30•Onsite

About The Position

Manage all facets of the behavioral health call center and behavioral health referral process. The scope of the screening and scheduling process begins with prompt management of the initial consumer or referent inquiry through to the scheduling an appointment with the best location of service at Unity Place. Responsibilities include, but are not limited to, answering incoming behavioral health calls being sensitive to patient's characteristics and needs, obtaining pre-certification or prior-authorizations, scheduling the initial service appointment with specialist or outpatient services, completion of documentation with the electronic medical record (EMR) and communicating referral information to referring offices and to the consumer.

Requirements

2yrs of Behavioral health experience

Responsibilities

Assessment and Coordination of Patient Appointments & Authorizations: Basic understanding of symptoms, causes, and treatment of mental health, addiction, and substance use problems to identify the proper location that best fits the consumer’s needs and insurance coverage.
Consistently answers the phone according to established call center metrics.
Knowledge of assessment process and how to use referral lookup to find results based on consumers need.
Coordinates appointments and relays authorization information to scheduling staff of location of service, as requested.
Schedules patients accurately in a timely and polite manner to ensure customer satisfaction.
Completes HCPC and SUPR coding.
Provides appropriate and timely documentation in the patient’s EMR using standardized workflows and processes.
Builds and maintains positive working relationships with all contacts
Acts as a liaison between Unity Place and all referral sources
Obtain Pre-Certifications and Prior Authorizations Services: Obtains insurance pre-certifications and prior authorizations for scheduled services including assessment, testing for patients.
Coordinates pre-certs and authorization processes with scheduling staff so appointments can be made in timely manner.
Obtains any and all pertinent clinic health information from provider, clinical staff and/or EMR to process authorizations, referrals, and pre-certifications.
Verifies demographic information, including insurance, when scheduling and/or obtaining pre-certifications.
Monitors outstanding authorization requests and initiates follow-up of outstanding authorizations in a timely manner.
Maintains current knowledge of payer specific requirements of prior authorizations by attending virtual workshops, researching, and reading newsletters.
Correspondence with Patients: Notifies patient of appointment details via telephone, MyChart, and letter.
Active listening and evidenced based practices (motivational interviewing, community reinforcement approach, and skills training)
Ensures patients are scheduled in first available appropriate appointment and location.
Reinforces instructions to patient per protocol.
Utilizes exemplary customer service skills with every patient interaction
Suicide assessment: can demonstrate appropriate utilization of Suicide Assessment scale and make appropriate emergency referral.
Ability to gather information to gain understanding of individual’s current situation and history to make an appropriate judgment on treatment location and patient’s readiness for treatment.
Independently handles communication in a manner that decreases conflict and demonstrates courteous, respectful and caring behavior with sensitivity towards consumers.