Primary City/State
Network Support Services Building 1
Category
Administrative Support
Shift
Day
Department
Customer Navigation-Referral Coordination
Great care starts with great people. (Like you.)
At HonorHealth, you'll find something special. From humble beginnings in 1927 to one of Arizona's largest nonprofit healthcare systems, our culture is built on warmth and neighborly kindness. Behind every smile is a highly skilled professional with deep expertise and an unwavering dedication to what matters most — caring for the health and well-being of people and communities across the greater Phoenix area.
Responsibilities
Job Summary
The primary contact for patients who contact the Customer Navigation Center regarding ambulatory specialty provider referrals. Primary role is to obtain referral authorizations, optimize care coordination, customer navigation, specialty appointment scheduling and support in-network referrals processing, Drive business to high quality, aligned specialists across our network.
Essential Functions
- Demonstrates high level knowledge of insurance requirements for referral authorization and care coordination Consistent coverage verification for patient appointments, including specialty referrals to HonorHealth Medical Group, PSAs, ACOs and aligned specialists in our network. Gather appropriate clinical documentation to support the referral authorization and subsequent specialty appointment scheduling. Keep current on all knowledge base articles and workflow changes posted in Teams Channels Document both ordering and receiving provider by name and location within Referral Management System and EPIC so patient journey can be properly monitored, data reporting can we accurate and any gaps identified early. Understand and utilize provider scoring for quality, access to care, location, insurance compatibility when sending referrals to specialists. Make the best fit recommendation when not otherwise indicated by ordering provider. Escalate any issues with provider data in Referral Management System or EPIC platforms so provider data can be quickly updated. Escalate any care availability or customer service issues with provider offices to Supervisor for follow up.
- Utilize internal and external resources to seek knowledge about insurance plans. Send proactive messages to both patient and ordering/ receiving providers about referral processing statuses. Meet productivity metrics and quality KPIs on a daily/ weekly basis.
- Performs other duties as assigned.
Education
- Associate's Degree or medical assistant certification - Preferred
- High School Diploma or GED - Required
Experience
- 2 years of call center experience - Required
- Other Typing a minimum of 45 words per minute (WPM) - Required
- Other Basic knowledge of insurance plans and requirements Knowledge of physician specialties and hospital services offered Knowledge of medical terminology - Required
- Other Bilingual in Spanish (conversation) - Preferred
Licenses and Certifications
- Successful completion of competency module (Level 2) upon hire - Required
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