Referral Coordinator

Position Summary:

Responsible for the daily workflow of the Medical Management Department and the processing of referrals in an efficient manner.

Essential Duties and Responsibilities:

1. Processes requests for authorization within established timelines.
2. Verifies enrollee eligibility and provider network status.
3. Interacts with provider offices to advise and educate on the referral process, assists with resolving issues, and obtains medical data.
4. Interacts well with co-workers, enrollees, and external customers.
5. Maintains enrollee confidentiality by following HIPAA rules and regulations, as well as internal compliance policies.
6. Receives and documents calls from providers via phone queue and addresses these in a professional manner using approved standard responses whenever applicable.

This job description in no way states or implies that these are the only duties performed by the employee occupying this position. Employees will be required to perform any other job-related duties assigned by their supervisor or management.

Qualifications:

• High School Diploma or general education degree (GED) and one to two years related experience and/or training; or equivalent combination of education and experience.
• Knowledge of Microsoft Excel, word processing software, database software, and electronic medical record navigation.
• Experience in data processing in a healthcare setting is a plus.

Skills and Abilities:

• Time management
• Prioritization skills
• Good communication skills
• Professionalism
• Ability to work in a fast-paced environment
• Flexibility with changing responsibilities

Work Schedule:

Community Care Plan is currently following a hybrid work schedule. The company reserves the right to change the work schedules based on the company needs.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, use hands, reach with hands and arms, and talk or hear. The employee is frequently required to stand, walk, and sit. The employee is occasionally required to stoop, kneel, crouch or crawl. The employee may occasionally lift and/or move up to 15 pounds.

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of the job. The environment includes work inside/outside the office, travel to other offices, as well as domestic, travel. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

We are an equal opportunity employer who recruits, employs, trains, compensates and promotes regardless of age, color, disability, ethnicity, family or marital status, gender identity or expression, language, national origin, physical and mental ability, political affiliation, race, religion, sexual orientation, socio-economic status, veteran status, and other characteristics that make our employees unique. We are committed to fostering, cultivating and preserving a culture of diversity, equity and inclusion.

Background Screening Notice:
In compliance with Florida law, candidates selected for this position must complete a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

The Clearinghouse is a statewide system managed by the Agency for Health Care Administration (AHCA) and is designed to help protect children, seniors, and other vulnerable populations while streamlining the screening process for employers and applicants.

Additional information is available at:
???? hhttps://info.flclearinghouse.com