Referral Coordinator Managed Care

Patient Services Representative Ii Under general supervision, operates as part of the care team performing a variety of functions such as obtaining referral/authorizations required for future appointments. Patient registration, insurance coverage and eligibility verification, scheduling and telephone management.

Distinguished characteristics: Rit Psr Ii is responsible for supporting all elements of referral and authorization to include validating patient's health plan eligibility and obtaining authorization for all services and procedures in office and external facilities. Contacting patients and scheduling into the Epic system by following SOP's provided by the Clinic. Contacting clinical staff to coordinate peer to peer calls between Physicians and the health plan as needed.

What you will do:

C-I-CARE (1, 2): Executes world class practices of service and patient care in support of C-I-CARE standards.

Uses C-I-CARE templates and the following components for all communication with patients and staff:

CONNECT with people by calling them their proper name, or the name they prefer (Mr., Ms., Dr.)

INTRODUCE yourself and your role

COMMUNICATE what you are going to do, how long it will take, and how it will impact the patient

ASK permission before entering a room, examining a patient or undertaking an activity

RESPOND to patient's questions or requests promptly; anticipate patient needs

EXIT courteously with an explanation of what will come next

Patient Registration (1,2): Registers new patients and updates existing patient accounts in a courteous and professional manner in accordance with performance standards.

Identifies accepted insurance plans and those requiring referrals.

Handles any system red flags as they are encountered.

Communication and Scheduling Procedures (1,2): Performs off-site scheduling of new or follow-up appointments in a courteous and professional manner in accordance with performance standards.

Coordinates and Communicates with Clinics

Electronic Health Record Documentation (1,2): Accesses EHR to communicate to clinical staff members and/or physicians through telephone encounters using SBAR format and/or appropriate smart phrases in accordance with performance standards.

Manages EHR in-basket(s), referral work queues in accordance with performance standards.

Referral & Authorization Coordination (1,2): Ensure patient registration is complete including demographic, insurance card and pharmacy benefits is obtained and scanned into the patient's chart in EPIC.

Confirm eligibility and re-verify when required.

Contact health plan for benefit information.

Review EPIC work queue for all request for office based services and procedures.

Defer for x amount days depending on services.

Work accounts that previously deferred for follow up as needed.

Schedule new consultation once authorization has been received and remind patients of scheduled appointments.

Collaborate with Revenue Cycle on authorization claim denials. Research and provide information to Insurance Follow Up Manager for claim appeals.

All other duties as assigned including department-specific functions and responsibilities (1, 2): Performs other duties as assigned and participates in organization projects as assigned.

Adheres to safety, P4P's (if applicable), HIPAA and compliance policies.

Provides orientation and training to new staff as assigned.

Education Qualifications

High School Diploma or GED Required

Experience Qualifications

1+ year to 2 years as a Patient Services Representative, referral pre-authorization experience and knowledge of revenue cycle functions in a physician office setting. Required

Required Knowledge, Skills and Abilities

Ability to type a minimum of 30 wpm

Strong verbal/written communication and listening skills; including excellent interpersonal skills and telephone communication.

Legible handwriting.

Ability to maintain composure during challenging interpersonal interactions.

Basic math skills necessary to collect payments and balance cash drawer.

Basic computer skills to include keyboarding, mouse movement and data entry skills to enter information into practice management system and EHR.

Ability to effectively organize and prioritize tasks in order to complete assignments within the time allotted and maintain standard workflow.

Ability to work with others in a flexible, cooperative manner.

Preferred Knowledge, Skills and Abilities

Experience in healthcare or related setting.

Physical Demands and Work Conditions Physical Demands

Constant Sitting.

Frequent Walking.

Occasional Standing.

Occasional Bending.

Occasional Squatting.

Occasional Climbing.

Occasional Kneeling.

Seldom Crawling.

Constant Hand Use.

Constant Repetitive Motion Hand Use.

Frequent Grasping.

Occasional Fine Manipulation.

Frequent Pushing and Pulling.

Occasional Reaching (above shoulder level).

Frequent Twisting and Turning (Neck and Waist).

Constant Vision (Color, Peripheral, Distance, Focus).

Lifting

Frequent lifting of 0 - 10 lbs.

Occasional lifting of 11 - 20 lbs.

Seldom lifting of 21 - 30 lbs.

Seldom lifting of 31 - 40 lbs.

Seldom lifting of 40+ lbs.

Carrying

Frequent lifting of 0 - 10 lbs.

Occasional lifting of 11 - 20 lbs.

Seldom lifting of 21 - 30 lbs.

Seldom lifting of 31 - 40 lbs.

Seldom lifting of 40+ lbs.

Working Environment

Occasional Driving cars, trucks, forklifts and other equipment.

Constant Working around equipment and machinery.

Seldom Walking on uneven ground.

Seldom Exposure to excessive noise.

Seldom Exposure to extremes in temperature, humidity or wetness.

Seldom Exposure to dust, gas, fumes or chemicals.

Seldom Working at heights.

Seldom Operation of foot controls or repetitive foot movement.

Seldom Use of special visual or auditory protective equipment.

Seldom Use of respirator.

Seldom Working with biohazards such as blood borne pathogens, hospital waste, etc..

Blood Borne Pathogens

Category III - Tasks that involve NO exposure to blood, body fluids or tissues, and Category I tasks that are not a condition of employment

Travel Requirements

10% travel:

These principles apply to ALL employees: Commitment to Providing an Exceptional Patient & Family Experience University HealthCare Alliance dba Stanford Medicine Partners sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery. You will do this by executing against our three experience pillars, from the patient and family's perspective:

Know Me: Anticipate my needs and status to deliver effective care

Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

Coordinate for Me: Own the complexity of my care through