Referral Navigator - EngageCONNECT

Description

JOB DESCRIPTION – Referral Navigator

I. Job Summary / Job Purpose

The Referral Navigator works with providers and clinics sending a referral, to ensure patient’s referral needs are fulfilled for specialty service office visits. Screens and assigns referrals, processes authorizations and pre-certifications for patients to ensure timely scheduling. Maintains consistent communication with team and senior management.

II. Key Responsibilities

• Gatekeeper for all incoming referrals sent to the EngageConnect patient referral center. 
• Monitor and maintain designated referral queue in an organized and efficient manner (Referrals, Documents, Telephone Encounters, Fax In-Box, etc.)
• Screen and assess all referrals to ensure correct patient demographics, Care Providers, and insurance eligibility. 
• If insurance payer requires, obtain PCP referral and/or prior authorization 
• Direct/assign referrals to the appropriate Referral Coordinator Specialist promptly. 
• Enter referrals, document communications and action into the system, as appropriate.
• Consult referring practice with complaint resolution and solutions related to patient referrals.
• Maintain performance and quality standards based on established EngageConnect metrics including turn-around times
• Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent      customer service, quality improvement and call reduction
• Perform other duties as assigned by EngageConnect manager or director.

III. EngageMED Core Expectations

At EngageMED, our purpose is to deliver strategies and solutions to impact the success of practices. We expect all our employees to live the values of Integrity, Respect, Innovation and Service:

• Honoring and caring for the dignity of all persons in mind, body, and spirit
• Ensuring the highest quality of care for those we serve
• Working together as a team to achieve our goals
• Improving continuously by listening, and asking for and responding to feedback
• Seeking new and better ways to meet the needs of those we serve
• Using our resources wisely
• Understanding how each of our roles contributes to the success of EngageMED.

IV. Core Job Competencies

Core EngageMED Behaviors: The following behaviors have been identified as critical to all staff roles at EngageMED:

• Teamwork Orientation: works cooperatively & collaboratively with others toward the accomplishment of shared goals.
• Service Orientation: desire to serve and focus one’s efforts on discovering and meeting the needs of internal and external      customers.
• Achieves Results: reflects a drive to achieve and outperform. Continuously looking for improvements. Accepts responsibility      for actions and results.
• Learning and Growth: has a commitment to continuous professional and organizational learning
• Communication: practices attentive and active listening and can restate opinions of others; communicates messages in a way that has the desired effect.

Role-Specific Behaviors: these additional behaviors are necessary in the role:

• Proficient knowledge of clinic referral and scheduling processes and billing/authorization requirements.
• Knowledge of federal and state pay requirements, including Medicare, Medicare Advantage, Medicaid, other Government and Commercial payers, HMO/PPO Contracts.
• Ability to communicate effectively and to maintain strict confidentiality.
• Ability to respond to people and issues promptly and appropriately, to resolve problems.
• A team player who handles multiple projects simultaneously in a fast-paced environment.
• Possess a strong work ethic and a high level of professionalism.

Skills, Knowledge or Abilities critical to this role:

• Language Ability: Ability to read, analyze and interpret general business periodicals, professional journals, technical      procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to common inquiries or complaints from groups of managers, clients, customers, and the general public.
• Math Ability: Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and      decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
• Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Computer Skills: Preferred proficiency in: Google Mail, Docs, Sheets; Microsoft Word, Excel, Outlook; Internet navigation, Healthcare payer portals
• EMR: Willing to learn/access multiple EMR portals as necessary to maintain continuity of care while upholding HIPAA      standards. Knowledge of eCW, NextGen, Cerner & Epic preferred

Qualifications

V. Job Requirements / Qualifications

Education / Accreditation / Licensure (required & preferred):

• High school diploma or equivalent required.

Experience (required and preferred):

· Excellent communication skills

· Proven ability to deal, professionally, with all stakeholders involved in the referral process

· Energetic and motivational individual with positive attitude and outcomes

· Skills in multi-tasking, efficiency operations and teamwork

· 5+ years of healthcare experience

· 2+ years knowledge/experience of government and commercial healthcare insurance plans 

VI. Disclaimers

• This job description reflects EngageMED’s assignment of essential functions, it does not prescribe or restrict the tasks that may      be assigned.
• Critical features of this job are listed above. They may be subject to change at any time due to reasonable accommodation or other reasons.
• This role is intended to be worked from on-site at EngageMED corporate office but may be asked to assist in remote operations during times of inclement weather or other extenuating circumstances.