Medical Referral Services Coordinator

Job Specifications:

Reports directly to the Medical Referral Office Lead responsible for providing warm and pleasant customer service in assisting members regarding issues and concerns such as but not limited to off-island authorization eligibility benefit administration claims billing reimbursements medical records etc. and administrative support to functions related to the Medical Referral Office processes.

Duties and Responsibilities:

I. Medical Referral Office Services

1. Greets and assists walk-in members.

2. Handles and documents check-in of walk-in members on log-sheet.

3. Helps/assists walk-in members connect with the right department and/or individuals

4. Answers incoming calls and directs them accordingly.

5. Forwards inquiries and concerns to appropriate staff/departments (e.g. other Medical Referral Office staff Medical Management Claims Customer Service MAS Sales etc.) or providers (e.g. doctors clinics hospital departments etc.)

6. Secures appointments for members related to their off-island referral.

7. Escorts members to providers clinics for their consultations and to departments within the provider facilities for various medical services and procedures.

8. Provides offsite letters of authorization to members for services not requiring prior authorization.

9. Provides assistance and support to members throughout the admission and discharge process for inpatients.

10. Computes and explains members financial responsibility by reviewing statements of account.

11. Provides customer support throughout the care coordination including but not limited to any of the following concerns:

11.1. Authorization (including Off-Island)

11.2.Eligibility

11.3. Benefit Administration

11.4.Referrals

11.5. Appointments

11.6.Claims

11.7. Billing

11.8.Reimbursements

11.9.Plan Deductible

11.10. Referrals (status & process)

11.11. Insurance Coverage

11.12. Coordination of Benefits

11.13. Services available

11.14. Network Providers/Access

11.15. Medical Records

11.16. Appeals

11.17. Grievances

12. Provides assistance to member for concerns related to off-island travel transportation accommodation etc.

13. Provides benefit information to members to facilitate understanding of benefit coverage plan limitations and exclusions.

II. Administrative Support

1. Collects updated membership information from walk-in members.

2. Updates and maintain member walk-in phone and email inquiry demographics on a weekly basis.

3. Updates and organizes member files.

4. Regularly inputs member-related information into the companys digital database.

5. Provides administrative support related to Medical Referral Office functions.

6. Performs other duties that may be assign from time to time.