Referral Processing
- Ensures specialty referrals submitted by providers meet patient eligibility This includes all out-patient referrals submitted by Medical, Dental, Eye Care, and Behavioral Health providers
- Processes all incoming referrals within 24 hours of receipt and following the Referral Policy when handling Routine, Urgent, and STAT referrals.
- Composes and mails patient pertinent appointment
- Submits prior authorizations through patient
- Processing all external referrals sent to CBHA for all services lines
- Process all internal referrals placed by CBHA providers to achieve optimal patient outcomes. This includes contacting patient and scheduling appointment
- Provides scheduling assistance to patients if
Responsible for the Referral Cycle
- Responsible for referrals tracking to completion, including out-patient, internal, and external referrals.
- Maintains ongoing tracking of scheduled
- Reviews the monthly referral activity
- Assist in the development and implementation of tracking
Responsible for developing specialty provider
- Serves as liaison between CBHA and Wellpoint, as well as other carriers and insurers.
- Maintains excellent customer service relations with specialty providers and
- Tracks and reviews the monthly utilization of specialty referrals.
Responsible for promoting applicable insurance
- Promotes insurance
- Handles confidential patient
Promotes a positive work culture and upholds clinic policies and procedures, including the WE CARE standards of
Must uphold confidentiality at all times in regards to CBHA activities, reports, financials, patient health information and other proprietary information specific to CBHA.