Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, reviews complex referral requests and evaluates and assigns appropriate specialist for the patient. Works with patients and providers to understand services being requested. Interviews patients as needed to obtain full understanding of what information is being requested. Works closely with Specialty Nurses to ensure clinical handoffs are safe and appropriate. Coordinates care both within client and with external partners.

• Reviews referral information from clinicians for pertinent information regarding tests,
  consultations, and procedures. Verifies demographics and insurance information. Work is highly complex and detail oriented, involving frequent contact with a range of internal and external contacts as well as the need to understand terms and processes of multiple payers.
• Scheduling routine colonoscopies and gastroenterology appointments
• Send out preparation documents to patients for procedures
• Reviews referral information from work queue for pertinent information regarding referral requests.
• Reviews each external referral for opportunity to convert to internal referral and reviews options with patients. Redirects patients with managed care products appropriately ensuring clinical handoff is safe using expertise of specialty nurses. Ensures adequate information is obtained and relayed when care is moved.
• Explains insurance benefits and options to patients. Explains denials to patients. Keeps
  patient informed of status of all referrals (approved and denied). Notifies patients of
  scheduled appointments and confirms appointment by mail including confirmed location and map of destination. Informs patient of any preparation that must be completed prior to the appointment. Contacts patient if insurance coverage issues arise during the referral process so that patient can work directly with the insurance company.
• Promotes the clients Health System of Care by highlighting internal providers and their
  expertise.
• As needed, places orders to start the referral process for the PCP on behalf of patients who have booked appointments and call for the referral. Researches the visit notes to determine if a referral was intended as well as processing referrals for follow-up or annual visits that require a referral.
• Schedules patients for tests, consultations, services and procedures with other departments, local private offices, and/or outside vendors/providers.
• Answers phone calls, faxed requests and other inquires relating to referrals and
  communicates with the physicians and clinicians to acquire authorization or to inform them of patient issues or clinical paperwork needed.
• Research questions/concerns from patients regarding bills and determines if issue is related to the referral process. Assists in resolving billing and denied referral matters as they relate to the referral process. Refers patients to appropriate staff (e.g., patient account representatives) for billing issues related to insurance benefits and services covered under the benefits plan.
• Works in collaboration with the person designated as the Practice's Benefits Coordinator to maintain cost control, ensure that services provided are within benefit plan guidelines, and that necessary policies and procedures are followed when dealing with non-preferred providers/vendors. May coordinate second opinion requests.
• Works with supervisors to ensure patients are receiving timely responses and detailed answers to their complex questions.
• Research questions/concerns from patients regarding billing and determines if issue is related to the referral process. Assists in resolving billing and denied referral matters as they relate to the referral process.
• Receives escalated issues and stat same day calls; determine appropriate action and/or works with clinical team for decision.
• Effectively deescalates issues with upset patients and practices. Uses advanced listening techniques to understand the issue and give patients options as they are available. Escalates to supervisors only as needed.
• Supports roles within the Navigator. Trains and teaches as needed.
• Participates in problem solving activities, focusing on productivity and quality. Works with supervisors to ensure continuous improvement of the department.

• Gastro background/knowledge
• Referral Experience
• Patient Check In Experience

• At least 2-3 years of experience
• EPIC Knowledge
• Scheduling Experience

• Monday - Friday: 8:30am to 5:00pm but can be flexible
• Onsite requirement during the contract phase but opportunity to go remote once proven.

• Business Casual- No Jeans, ripped clothes, or sneakers