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Referral Coordinator in Rhode Island at Prospect Medical Systems

Date Posted: 6/20/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Central Avenue
    Rhode Island
  • Job Type:
    Other
  • Experience:
    Not Specified
  • Date Posted:
    6/20/2018
  • Job ID:
    9821

Job Description



Referral Coordinator

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Referral Coordinator prepares all referrals and coordinates them for review or denial. Assist the Referral Nurse and Medical Directors daily with additional information needed or benefit verification. Responsible for maintaining stat line. Documents pertinent information in Cerecons and IDX referral system.



Job Responsibilities/Duties

  • Processes and coordinates reviews all referral requests. Approves referrals off Auto Approval list for coordinators. 
  • Documents all pertinent information in Cerecons and IDX. Maintains pod and referral queues to ensure turn around time is three days from date of receipt per policy.
  • Handles stat calls for assigned team on a daily basis and adhere to department standards for coverage.
  • Answers all voice mail at least every hour and respond to messages within 24 hours to ensure customer satisfaction is maintained.
  • Daily eligibility and benefit checks on referrals to ensure proper handling of case.
  • Assures all referrals are maintained within appropriate networks.
  • Inputs 150 determinations per day set by department standard.
  • Assist with setting up temporary contracts for new providers by obtaining all necessary information and forwarding to the contracting department by email or via the 'pending contracting' queue in IDX.
  • Fowards Disease Management cases to the Health Education Department daily.
  • Special duties: Assist with special projects as assigned by management.


Qualifications

Minimum Education: High School diploma.

Minimum Experience: Medical Assistant with prior HMO / Medical Group experience, 50 WPM (minimum).

Req. Certification/Licensure: Medical Terminology certificate. Certified Medical Assistant.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Referral Coordinator.