MHC Healthcare is seeking a Referral Specialist to join the MHC team at the Wilmot Family Health Center, located in Tucson, AZ. Under the direct guidance of medical providers, the Referral Specialist performs all duties related to assisting patients requiring care from specialty providers and agencies. The Referral Specialist facilitates patient referrals and authorizations by completing required documents, interfacing with providers, health plans and patients. The Referral Specialist coordinates with the specialty office to ensure proper follow-up happens and that needed documentation is provided. MHC Healthcare is a Federally Qualified Community Health Center (FQHC), with 16 sites in Tucson and Pima County. Our mission is to improve our Community by providing exceptional, whole-person healthcare.
The following qualifications are required:
- High School diploma or equivalent
- Fingerprint Clearance Card through the Arizona Department of Public Safety (or ability to obtain upon hire)
The following qualifications are preferred:
- Knowledge of medical terminology.
- Experience working in a health care setting.
- Medical Assistant Certification.
Equivalent combination of education and experience may be considered if applicable and must be directly related to the functions and body of knowledge required to successfully perform the job.
This position has the following supervisory responsibility:
- Does not direct or supervise others.
The ideal candidate will also possess the following knowledge, skills, and abilities:
- Knowledge of insurance referral process.
- Basic computer skills using basic referral system, experience with AHCCCS and Managed Care Plans.
Duties and Responsibilities:
- Demonstrates an understanding of managed care referral and authorization process, with knowledge of health plan resources and contacts for facilitating timely and effective patient referrals.
- Accepts and returns patient phone calls timely, communicates in a reassuring manner.
- Maintains up-to-date resource materials and disseminates pertinent updates to providers and support staff.
- Completes correct forms and information required to facilitate request to include ICD-9/CPT codes and descriptions, signatures, number of visits, specialist information and medical record documentation.
- Serves as a resource to providers, support staff and patients regarding referral and authorization process, researches questions thoroughly and assists with interpretation of health plan guidelines.
- Maintains effective recordkeeping system that includes a checklist for contacting the health plan, patient and specialist/outside service, and a tickler file for follow-up and status file/log for pending referrals.
- Documents communications with health plans and other entities as appropriate to apprise providers and facilitate process.
- Prioritizes requests, responding immediately and expediting most urgent requests.
- Alerts providers immediately of denials or other problems affecting referrals.
- May provide cross-functional referral services by assisting other MHC facilities in need of referral assistance.
- Assists with effective medical records management by accurately obtaining pertinent information from patient charts and returning medical records to file expeditiously.
- Demonstrates competency in utilizing office equipment to include computer, printer, facsimile, photocopier and telephone system.
- Performs all other related duties as assigned.
Benefits:
MHC Healthcare’s vision is to be the premier provider and employer in community health. To support our mission and vision in our community, MHC Healthcare believes health and well-being must start at home. Therefore, employees have many opportunities to care for our own health and wellness with benefits such as:
- Medical, Dental, and Vision
- 403(b) with employer contribution
- Short-term disability and other benefits
- Paid time off including 11 holidays plus vacation and sick leave accrual
- Paid bereavement, jury duty, and community service time
- Employee discount for medical services ($500 per year for full-time)
- Education reimbursement ($3,000 per year for full-time)
MHC Healthcare will recruit, hire, train, and promote persons in all job titles without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or an other characteristic protected by law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Other details
- Job Family Business Operations
- Pay Type Hourly
- Min Hiring Rate $16.17
- Max Hiring Rate $19.25
- Required Education High School
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