Referral Specialist Navigator (0001M) (68083)

VARIETY CARE INC•Oklahoma City, OK

7d•Onsite

About The Position

Referral expertise in all service lines and overall understanding of community resources, insurance and Medicaid knowledge. Oversees team by service line to maximize timely processing and closure of referrals. Maximizes teams use of digital health solutions and portals to maximize referral communication between targeted organizations. Proactively reaches out to high volume specialists to build communication and enhance relationships. Consistently exceeds Referral Specialists productivity standards. Primary Duties and Responsibilities: Trains new Referral Specialist team members and actively trains team members on workflow improvements and performance standards. Coaches team members as needed. Delegates new referrals to team members each day, evenly and fairly, and provides support to team on hard-to-place referrals. Understands and ensures the workflows for insurance verification, SC-10 requests and pre-authorization requirements and are followed throughout the team. Identifies team closure activities and uses reports to help prioritize referrals to maximize loop closure. Acts as liaison between service line providers and staff to address provider complaints or referral challenges with appropriate resolution and follow up. Follows proper procedures to assure pending referrals are complete and team following all workflows effectively. Troubleshoots day to day work related issues with team and provides feedback to supervisor. Follows HIPPA guidelines and Variety Care privacy policy and procedures. Submits weekly status reports to PAS Administrator and Chief of Patient Engagement on progress and updates within their service line. Supports Variety Care’s accreditation as a Patient Centered Medical Home and our commitment to provide care to all Variety patients that is Safe, Effective, Patient Centered, Timely, Efficient, and Equitable. Provide leadership and work with all staff to achieve the goals of the “Triple Aim” of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs. Embodies the strength of personal character. Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment. Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable. Embodies the strength of personal character. Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment. Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable. Performs other duties as assigned.

Requirements

One year of experience with referral processing and workflows.
Experience in EPIC referral workflows and processes.
Expert communication skills.
Experience leading team in their service area to achieve productivity goals.
Experience acting as key liaison with Service line directors and providers for referral expertise.
Understands rules and regulations of Medicaid, expert in pre-authorization requirements.
Experience working with hard to close referrals and experience handling patient complaints effectively.
Experience in leadership of assigned workque and overall performance measures.
Experience independently processing Medicaid SC-10 requests in timely manner.

Nice To Haves

Bilingual (Spanish/English).
Background knowledge of a medical environment.
Understands medical terminology.

Responsibilities

Trains new Referral Specialist team members and actively trains team members on workflow improvements and performance standards.
Coaches team members as needed.
Delegates new referrals to team members each day, evenly and fairly, and provides support to team on hard-to-place referrals.
Understands and ensures the workflows for insurance verification, SC-10 requests and pre-authorization requirements and are followed throughout the team.
Identifies team closure activities and uses reports to help prioritize referrals to maximize loop closure.
Acts as liaison between service line providers and staff to address provider complaints or referral challenges with appropriate resolution and follow up.
Follows proper procedures to assure pending referrals are complete and team following all workflows effectively.
Troubleshoots day to day work related issues with team and provides feedback to supervisor.
Follows HIPPA guidelines and Variety Care privacy policy and procedures.
Submits weekly status reports to PAS Administrator and Chief of Patient Engagement on progress and updates within their service line.
Supports Variety Care’s accreditation as a Patient Centered Medical Home and our commitment to provide care to all Variety patients that is Safe, Effective, Patient Centered, Timely, Efficient, and Equitable.
Provide leadership and work with all staff to achieve the goals of the “Triple Aim” of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs.
Embodies the strength of personal character.
Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment.
Must be a leader in the department and community.
Result-oriented problem solver who is responsible and accountable.
Performs other duties as assigned.