Referral Coordinator III

Referral Coordinator IIIJob Summary:The Referral Coordinator III serves as a senior member of the Referral Coordination team providing day-to-day workflow guidance subject matter expertise and operational support to ensure efficient high-quality Referral Coordination addition to managing a complex caseload and performing all core Referral Coordinator responsibilities this role supports team productivity quality outcomes process improvement initiatives and the implementation of Referral Coordination best closely with the Referral Coordination Manager the Referral Coordinator III acts as a resource for colleagues helps identify and address operational barriers assists with onboarding and training and provides feedback on team performance and process effectiveness. This role requires advanced knowledge of referral management healthcare operations and Referral Coordination workflows along with a strong commitment to member experience and clinical Coordination & Member SupportProvide day-to-day oversight of assigned Referral Coordination pod activities including call queue management referrals durable medical equipment (DME) and diagnostic imaging (DI) workflows ensuring productivity quality and service standards are and communicate team and individual productivity and quality outcomes providing the Referral Coordination Manager with insights regarding performance trends barriers opportunities for improvement and key an exceptional member experience by managing member communications including returning calls routing inquiries appropriately and providing timely updates and information regarding referrals diagnostic imaging orders and related in the recruitment and interview process for Referral Coordinator the onboarding and precepting of new referral coordinator the implementation and pilot testing of new workflows processes and initiatives providing detailed feedback and recommendations to process owners and as a subject matter expert and primary resource for daily workflow guidance problem resolution and Referral Coordination best referrals to external providers vendors and services to ensure members receive timely access to appropriate care and accurate complete and timely documentation to support referral management and continuity of and maintain strong relationships with members and their families to facilitate effective Referral Coordination and a positive member out activities outlined in members care plans and support ongoing follow-up to ensure care plan goals and recommended services are effective communication and collaboration among care teams providers specialists and external partners to support positive member members in navigating healthcare financial and social barriers to care including coordination of transportation interpreter services prescription assistance and other support resources as as a trusted point of contact and system navigator for members and families addressing questions concerns and Referral Coordination compliance with HIPAA regulations and all organizational policies related to privacy confidentiality and protected health information (PHI).Partner with center market and enterprise stakeholders to support Referral Coordination goals and organizational communication between Referral Coordination teams and leadership to promote consistency and best-practice change management efforts and champion adoption of new workflows and Skills/Abilities:Demonstrates a high degree of emotional intelligence integrity professionalism and accountability with a strong results-oriented work -motivated and resourceful with the ability to think strategically solve complex problems and execute effectively in a dynamic strong relationships and collaborates effectively with colleagues providers members caregivers vendors insurance partners and leaders across all levels of the verbal and written communication skills with a customer-centric approach and the ability to influence diverse critical thinking decision-making and problem-solving skills with the ability to assess risks identify root causes and implement sustainable ability to manage multiple priorities simultaneously while maintaining a high degree of organization accuracy and attention to to develop constructive and cooperative working relationships that foster trust engagement and performance feedback coaching and competency assessments to support colleague development and continuous understanding of healthcare operations Referral Coordination utilization management and value-based care knowledge of the healthcare ecosystem including payer operations insurance benefits referral management and authorization interpreting and analyzing claims quality utilization and operational performance data to identify trends and drive with healthcare analytics and reporting tools and the ability to translate data into actionable knowledge of medical terminology CPT and ICD-10 coding and Medicare coverage criteria related to equipment supplies and specialty for improving health outcomes and supporting seniors in successfully navigating their care with Microsoft Office Suite including Word Excel PowerPoint Outlook and other business productivity skills including Spanish or other languages commonly spoken in the communities we serve are preferred where and willingness to travel periodically for training meetings and business and serves as a role model of ArchWell Health values: Be compassionate strive for excellence earn trust show respect stay resilient and always do the right thing. Minimum Qualifications:High School Diploma or equivalent required; Associates degree or coursework in Healthcare Administration Health Sciences or a related field from a nationally accredited Medical Assistant program or equivalent healthcare vocational training (e.g. paramedic military medic foreign-trained physician or similar clinical background) of three (3) years of experience in referral management Referral Coordination or healthcare operations within a primary care managed care or value-based care environment experience managing complex referrals authorizations specialty scheduling diagnostic imaging and durable medical equipment (DME) processes serving as a mentor trainer subject matter expert or informal team lead working with Medicare populations and geriatric patients strongly in eClinicalWorks ArchWell Health:At ArchWell Health were creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship routine wellness and staying active our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard listened to and given ample time by their physicians to live well later in value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable accessible neighborhood centers where older adults can feel at home and become part of a vibrant wellness-focused community. Were passionate about caring for older adults and united by the belief that caring has the power to change everything for our Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race color religion age sex sexual orientation gender identity national origin disability veteran status or any other protected classification.