The Patient Referral Specialist is responsible for managing and tracking all referrals made by PCHS providers to other health care providers.
Essential Duties and Responsibilities
- Assist in the coordination of care for patients by finding contracted providers and facilitating appropriate care
- Work with members and providers on benefit clarification and prior authorizations
- Coordinate with Navigators to assist patients in completing application for coverage
- Review and process all managed care referrals to ensure necessity, patient eligibility, covered benefit, and prior authorization
- Communicate approval or denial of referral to patients and providers
- Help track all referrals written to specialists and/or facilities, as well as provides referral and benefit information to medical staff to ensure efficiency and appropriateness of referral request
- Act as a liaison to health plans; providing customer service to patients and providers with referral or insurance related questions and address complaints and other issues as needed
- Research and compile the referral grid
- Serve in a care coordination role for the Breast, Cervical and Colon Health Program (BCCHP), which includes processing paperwork, reviewing eligibility criteria, and coordinating into the Cancer Treatment Program, if needed
- Familiar with using electronic health record (Ex. Athena and NextGen)
- Other duties as assigned
Supervisory Responsibilities
This position has no direct reports.
Qualifications
- One (1) year of customer service experience (preferred)
- One (1) year of billing experience (preferred)
- Familiarity with local resources (preferred)
Compensation: starting at $17.13 - $23.49
Skills
Must have excellent communication skills. Ability to work independently and as part of a team; to receive and respond well to feedback. Possess strong interpersonal and problem-solving skills; time-management and organizational skills, including being punctual, responsive, and efficient. Perform job with professionalism and good judgment.
Work Environment and Physical Demands
With multiple locations and settings, PCHS’ work environment and physical demands vary greatly depending on the employee’s role. Essential job functions include the following: The employee is required to talk, hear, see, smell, sit and stand. The employee is frequently required to move around the facility; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. The employee is frequently required to lift and/or move up to 10 pounds and occasionally required to lift and/or move up to 25 pounds. Employees may be exposed to mechanical parts and moderate noise levels. Reasonable accommodations may be available to individuals with disabilities to perform their essential job functions.
Equal Opportunity
Peninsula Community Health Services is an equal opportunity/Affirmative Action employer and does not exclude persons from employment or application for employment from receipt of or participation in programs, activities, services on the grounds of race, color, sex, national origin, age, military status, marital status, religion, the presence of a physical, mental, or sensory disability, sexual orientation, gender identity, genetic information, victim of domestic violence, sexual assault or stalking, or any other characteristic protected by federal, state or local law.
Vaccination
PCHS requires that all employees provide proof of specific vaccinations. All offers are contingent, and your vaccination status will be verified during onboarding.
Make a Difference with PCHS
Join Peninsula Community Health Services (PCHS) in making a difference in people's lives and the surrounding community every day. PCHS exemplifies a culture of community service that is Patient Driven, Empathetic, and Staff Empowered. We are, a Federally Qualified Health Center supporting access to healthcare services (medical, dental, pharmacy, behavioral health) for Kitsap County, Mason County, and Rural Pierce County.
Our Mission
PCHS exemplifies a culture of community service. Our patients come from all walks of life. PCHS services are available to our patients without regard for ability to pay.
Our Vision
PCHS strives to eliminate healthcare disparities in our community. We have medical and dental clinics located throughout Kitsap and Mason and rural Pierce County and a dedicated team working together to create a care plan that’s right for you. We also bring that care directly to our patients who can’t easily make it into our traditional clinics through our mobile clinics, school-based health centers, and by partnering with our community service agencies to deliver care on their premises.
Our Guiding Principle
Here at PCHS, our guiding principle is to see and value every person. We believe all patients have the right to be treated with respect and dignity with an acknowledgment that this includes their cultural, social, spiritual, and personal values and beliefs.
Our Core Values
Every member of PCHS stands by our Core Values: Patient driven. Empathetic. Staff Empowered.
