Patient Referral Specialist

Spectrum Healthcare Resources has a potential need for a Patient Referral Specialist. These will be completely remote positions, working entirely from the referral specialist's home. The Patient Referral specialist will ensures accuracy and completion of authorization data from customer information, medical records, referral/authorization forms, Military Treatment Facility electronic transmission and other documents into medical management system. The Patient Referral Specialist will be working Monday through Friday, 8 hours per day.

Requirements

High School Diploma or G.E.D.
• 2+ years' experience in a health care customer service environment
• Experience with Microsoft Office

• Preffered:
• Knowledge of medical terminology
• Managed Care experience
• TRICARE experienceKey Responsibilits

• Key Responsibilities:
  • Assess beneficiaries to identify medical, physical, and psychosocial needs to support the beneficiary's overall goals of car
  • Assesses tasks for authorization/referral request to ensure accurate entry into the medical management system.
  • Identifies potential discrepancies in the medical management system to assure quality compliance.
  • Consistently meet department productivity and performance metrics.
  • Documents the receipt of returned correspondence via the medical management system.
  • Follow HIPAA compliance and TriWest confidentially guidelines.
  • Refers beneficiaries to network providers.
  • Resolves issues to complete care request.
  • Reads communications detailing diagnosis and requested services and procedures
  • Assists in producing trend reports to improve workflow efficiency and system functions to recommend possible solutions to management.
  • Assists with resolving data quality issues by identifying, documenting, and communicating quality issues
  • Resolve process issues to ensure high quality service levels throughout TriWest. Seeks advice and escalates issues or problem as warranted.
  • Processes referrals for Behavioral Health, Specialty Care, Durable Medical Equipment, Inpatient Admissions, Military Treatment Facilities, and Urgent referral and authorization requests. o Assesses electronic documents to ensure appropriate entry into the medical management system. o Works with standard coding systems including: standard medical taxonomy, ICD-10, CPT and HCPCS codes.

• Highly organized, self-directed worker able to function in a high-volume environment without distractions.
• Strong verbal and written communication skills.
• Proficient level of experience with Microsoft Office applications and strong technical aptitude.
• Must have access to secure, high speed internet.

Company Overview:

Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals.

Spectrum Healthcare Resources is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

EOE/AA/Disability/Vet