Referral Specialist - Hybrid/Remote
Job title: Referral Specialist - Hybrid/Remote in Dover-Foxcroft, ME at Northern Light Health
Company: Northern Light Health
Job description: Job Description:Northern Light Mayo HospitalDepartment: Physician Practice Central OpsPosition is located: Medical Office Bldg- Dover FoxcroftWork Type: Full TimeHours Per Week: 40.00Work Schedule: No Hours AssignedPosition does have the opportunity to be a remote after onsite training is completed.Summary:Responsible for facilitating the management of requested medical services for appropriate utilization of resources, by evaluating referral requests for eligibility, benefit determination, preferred provider networks, level of care and medical necessity. In conjunction with the Medical Director, Nurse Case Manager and Management Team.Responsibilities:
- Ensures integration of referral management activities with other areas of medical management: Compliance, Case Management, and Quality Management. • Performs the dynamics of referral entry, authorization or denial, and documentation according to internal policies and procedures. Procedures include phone-in referral system where all members of the team answer calls within a phone queue to expedite service. • Demonstrates the ability to utilize medical necessity criteria, scope of benefits, health plan criteria and medical director leadership appropriately. • Works aggressively with physicians and physician office staff to obtain necessary medical information related to referral requests. • Assists with cross coverage within the referral management team as assigned. • Communicates and works with members, member services, provider relations, management, medical leadership and administration. • Maintains files and records of referral activity. • Performs other duties as assigned by the office coordinator. • Meets or exceeds referral department productivity targets on a weekly basis. • Participates in the joint and coordinated actions of the referral coordinator team. • Demonstrates initiative, motivation and resourcefulness in day-to-day operations.
- Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
- Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
- Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
- Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
- Required High School Diploma/General Educational Development (GED)
- Work with computers, typing, reading or writing.
- Prolonged periods of sitting.
- Prolonged periods of walking.