The Eligibility/Referral Specialist is a hybrid position; a cross between two professional roles. In this position, you will be responsible for performing the duties of both roles to support Agape Community Health Center, Inc (AFH). The hybrid role will be responsible for providing patient care coordination that will support AFH passion to decrease barriers to care while providing exceptional care to everyone.
The referral role is responsible for coordinating specialty care for patients in need of external consultation as requested by the primary care physician. The Referral Coordinator will also be responsible for scheduling, tracking, and providing report logs on referrals. The eligibility role assists patients with eligibility for government programs, Agape Family Health’s sliding fee discount program and other options for managing patients access to health care
Essential Duties and Responsibilities:
Core Responsibilities of Referrals:
- Calls patients to schedule advanced and same day referral appointments and accurately enters new or follow-up information into the electronic health records system
- Maintains and updates any patient referrals as requested
- Completes and verifies patient eligibility and authorizations
- Obtains all authorizations for referrals
- Have working knowledge of insurance portals
- Informs and guides patients to appropriate resources
- Obtains, verifies, and/or updates demographics and insurance information in the appropriate EMR
- Maintain daily logs of patient referrals
- Maintain follow up with patients to ensure timely processing of referrals.
Core Responsibilities of Eligibility:
- Serve as the point of contact for all eligibility assistance related questions. Communicate with patients to identify and understand financial, social, and medical histories and other relevant patient information.
- Determine the patient’s financial ability to pay and explain insurance coverage and benefits to the patient.
- Initiate the eligibility screening process as appropriate to evaluate eligibility for assistance programs.
- Determine and explain the patient’s financial ability to pay according to AFH’s sliding fee discount program,
- Assist the patient in completing the sliding fee discount program application including providing patient an explanation of financial documentation needed to complete eligibility process.
- Follow up with patient as necessary to complete eligibility.
- Schedule office visits for patients after eligibility is determined.
- Document the patient category of approval in the EMR and provide patient with eligibility information.
- Update insurance and/or eligibility information
- Ability to complete & obtain ACA Marketplace Certification or other certifications as needed
Customer Service Standards:
- Support co-workers and engage in positive interactions.
- Communicate professionally and timely with internal and external customers
- Demonstrate friendliness by smiling and making eye contact when greeting all customers.
- Provide helpful assistance in anticipating and responding to the needs of our customers.
- Collaborate with customers in planning and decision making to result in optimal solutions.
- Ability to stay calm under pressure and deal effectively with difficult situations.
- Other duties as assigned.
The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.
Education and Experience Requirements:
- High School diploma or equivalent is required.
- Associates degree in Business Administration is preferred.
- A minimum of one year of experience in insurance or referrals is required.
- Two years of experience in healthcare revenue cycle is preferred.
- Must independently recognize and evaluate situations for the level of urgency.
- Excellent written and oral communication skills.
- Maintains effective and cooperative working relationships with co-workers, leaders, clinical staff and the general public.
- Must be detail oriented and accurate.
- Ability to multi-task and prioritize tasks.
- Displays an aptitude and willingness to learn new responsibilities.
- Willingly accepts feedback.
- Flexible and innovative.
- Ability to problem-solve and work independently.
- Displays a professional appearance.
- Dependable and reliable in achieving goals.
- Experience operating office machines such as personal computers, fax machines, photocopier, and document scanners.
- Familiarity with medical terminology and abbreviations.
- Proven ability to maintain confidentiality of sensitive information.
Skill Requirements: (X = Required for job)
X Typing/computer keyboard
X Utilize computer software (specified above)
X Retrieve and compile information
X Public speaking/group presentations
X Research, analyze and interpret information
X Verify data and information
X Investigate, evaluate, recommend action
X Organize and prioritize information/tasks
Leadership and supervisory, managing people
X Operate office equipment
X Basic mathematical concepts (e.g. add, subtract)
X Advanced mathematical concepts (fractions, decimals, ratios, percentages, graphs)
X Abstract mathematical concepts (interpolation, inference, frequency, reliability, formulas, equations, statistics)
Physical Requirements: (X = Required for job)
X Sitting for extended periods
X Lifting/carrying up to 20 pounds various items
X Standing for extended periods
Lifting/carrying more than 20 pounds various items
X Extended periods viewing computer screen
Hazards: (X = Required for job)
X Normal office environment
X Electrical current
Toxic or caustic chemicals
Housekeeping and/or cleaning agents
Flammable, explosive gases
Proximity to moving mechanical parts