Home Health Intake Referral Specialist
US-NM-Albuquerque
Careers (External)
Req #: 48269
Type: Full Time
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Overview: Presbyterian is hiring an Intake Referral Coordinator to serve as the Clearing House, Centralized Agency Representative for receiving all incoming calls/ clinical referrals from patients/members/providers and coordinating services from all community providers and designated PDS Hospitals and PMG clinics. Responsible for recognizing both expressed and implied customer needs and recommending the solution that will meet consumers desired outcomes. Gather all information needed to perform research and analysis for verifying member/patient eligibility/insurance/ongoing Authorizations and make decision regarding a referral to PHH, Hospice and Palliative Services as determined by payor sources/guidelines. Referring patients & providers to PHH clinical staff when assistance is needed with a more complex array of services or any inpatient levels of care. Assisting patients in finding appropriate providers for PHH services and availability within New Mexico and state border areas. Triages and manages complaints/problem calls from Patients. How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community. At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members. Why Join Us * Full Time - Exempt: No * Job is based at Remote Presbyterian El Camino * Work hours: Days * Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees. Responsibilities: * Responsible for clearing the 18 Account/Billing/Claim Edit & registration Work Queue issues. Communicates to patient and family any benefit limitations, corrects and completes all insurance corrections to avoid write offs within timely filing guidelines. Demonstrates knowledge and understanding of managed care principles, payor, benefit information and practices and supports the financial goals of the organization * Confirms signed orders from providers to ensure timely billing and that payments are processed within regulatory requirements to perform ordered services. Coordinate and submits authorization for services and documents appropriately into the computer system. * Receives triages, and processes incoming referrals/calls from multiple sources including CDS & Regional HH Agency patients/providers and transcribes the necessary information. Enters the necessary referral information, including demographic, confirmed payor source information to process the referral. Gather clinical information from callers to determine clinical needs of member, referring members to appropriate PHH providers and obtaining authorizations as needed. * Serves as the Clearing House, Centralized Agency Representative to facilitate the processing of the health referral to the receiving Community Agencies as determined by the patients Freedom of Choice and confirm placement for continuity of care. Follow up as necessary with community agencies, ordering providers, and patients/families if timely Start of Care does not occur for replacement agency. * Coordinates and meets internal and external customer service expectations by recognizing both expressed and implied customer needs and recommending the solution that will meet the callers desired outcomes and achieve Patient Satisfaction Goals. Responsible for explanation of PHH programs and obtaining patient/family consent for admission. * Develops and maintains a working knowledge of all PHH service and resources available within the community, state and state border areas by developing & maintaining relationships with state wide agency personnel both in/outside the organization. * Work with PHH clinical staff to refer members that require complex care coordination to the appropriately trained and assigned PHH clinical staff. Coordinates the services required for Intake of program services to include DME, Oxygen, etc.; working with the clinician and or agency to provide services as ordered. * Assumes responsibility for professional growth, development, and cross training activities for various program and shifts. Qualifications: * High School Diploma or GED required. Associate degree preferred. * Five (5) years experience working in a health facility required or 3+ years Insurance processing experience and direct patient contact required. Education Essential: High School Diploma or GED
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