Referrals Coordinator

Marathon Health

22h•Remote

About The Position

The Referral Coordinator facilitates patient referrals for Marathon Health’s Value Driven Referrals service. This role serves as a subject matter expert (SME) in using data and analytic tools to identify the highest quality, lowest cost specialists based on the patient's geography, insurance, and specific referral needs. The coordinator acts as the primary liaison between the patient and the referral specialist office, ensuring that the patient's preferences (urgency, quality, cost, location, availability, accommodations, etc.) are communicated and reflected in the care coordination.

Requirements

High School Diploma and 2+ years of experience in a medical office, central scheduling or in a clinical navigator role or equivalent combination of education and experience.
Experience with insurance plans and companies, third-party payer practices and guidelines, and precertification and referral management for insurance plans.
Experience and ability to interview and obtain medical information from medical providers, medical assistants, and patients in a professional and courteous manner.
Knowledge of and experience with medical terminology and procedural coding.
Ability to interpret insurance information on PPO/EPO/POS/HMO/QPOS plans.
Knowledge of Privacy Act and HIPAA Privacy Rule standards to maintain compliance, and to secure and protect medical and other protected health information.
Ability to work remotely in a secure confidential location; in a distraction-free without interruptions environment; with sufficient internet connections; and during the established schedule.
Strong computer literacy with technical expertise using Microsoft Teams and Microsoft 365 including Word, Excel, Outlook, PowerPoint, etc.
Excellent written and oral communications skills.
Ability to communicate medical information with clients, patients, business leaders and professionals.
Exceptional customer service skills and ability to promote teamwork.
Ability to build and maintain trusting relationships by approaching all work with integrity and commitment.
Meticulous attention to detail and excellent time management skills and ability to multi-task, prioritize work, execute a plan, and meet deadlines.
Flexibility and adaptive skills with the ability to effectively manage competing priorities in a constantly evolving workplace in a fast-paced environment.
High level of critical thinking, and creative and effective problem-solving skills.

Nice To Haves

Experience successfully working remotely in a virtual setting preferred.
Experience working on dual monitors preferred.

Responsibilities

Be the subject matter expert (SME) for all referral order types to ensure the patient receives the best opportunities for care.
Knowledgeable of requirements and special considerations for visits with any specialist type order, requirements for all imaging order types, durable medical equipment, and more.
Interview patients with orders from a Marathon Health provider to obtain patient preferences for care and to obtain any additional medical information necessary for care navigation.
Advocate and assist patients in problem solving potential issues related to their care.
Aid patients, Marathon providers and clinic teammates with inquiries about the best options of care with respect to quality and financial considerations for the patient outside of Marathon Health.
Facilitate the Value Driven Referral service as the assigned direct point of contact for the patient.
Schedule appointments on behalf of the patient and communicate appointment details to the patient, specialist office, and Marathon clinic team.
Act as a subject matter expert (SME) to understand the employer’s benefit package and insurance plan.
Answer questions from the patient about their insurance plan and how coverage works to empower the patient to make the best choices for their care.
Complete prior authorization requirements for care coverage.
Provide medical information from the Athena chart like the patient history, diagnosis and the rule-out reason for referral.
Provide any information to insurance companies to maximize reimbursement to the clinic and providers.
Deliver exceptional customer service that is in alignment with a concierge service type.
Be available to answer incoming calls on the shared Referral Team phone line and personal calls in a timely fashion.
Responsible to document in multiple systems, such as Salesforce, Athena (EMR), OneNote, Availity (and other insurance sites) and Excel.
Request medical records post appointment to close the loop on patient care with the strictest confidentiality to maintain company integrity, patient and provider confidentiality, third-party administrator confidentiality and security of all data and records.

Benefits

Free Marathon membership for in person and virtual care
Employer paid life and disability insurance
Choice in medical/dental plans
Vision
Employer funded HSA
FSA
Voluntary illness, accident and hospitalization plans
Competitive compensation
401k match
Access to financial coaching through our Employee Assistance Program
Paid time off for vacation, sick leave, and more
Holiday schedule
Unlimited, free primary care, routine labs, select prescriptions, vaccinations, and virtual mental health care for you and your family
Choice of 2 medical plans
2 dental plans
Vision coverage
Unlimited free mental health benefits and EAP resources
Rewards for challenges and healthy lifestyle activities
Family-building and hormonal health benefits
Paid parental leave
Generous PTO or FTO
Paid Holidays + A Day for What Matters
Company paid Basic Life and Disability insurance
Supplemental Life
Spending Accounts
401(k) with employer match and graded vesting
Continuing Medical Education (CME) for maintaining and strengthening the knowledge, skills, and expertise of our health center teammates, as applicable