Coordinator II - Customer Navigation

Responsibilities

• Demonstrates high level knowledge of insurance requirements for referral authorization and care coordination
• Consistent coverage verification for patient appointments, including specialty referrals to HonorHealth Medical Group, PSAs, ACOs and aligned specialists in our network
• Gather appropriate clinical documentation to support the referral authorization and subsequent specialty appointment scheduling
• Keep current on all knowledge base articles and workflow changes posted in Teams Channels
• Document both ordering and receiving provider by name and location within Referral Management System and EPIC so patient journey can be properly monitored, data reporting can be accurate and any gaps identified early
• Understand and utilize provider scoring for quality, access to care, location, insurance compatibility when sending referrals to specialists
• Make the “best fit” recommendation when not otherwise indicated by ordering provider
• Escalate any issues with provider data in Referral Management System or EPIC platforms so provider data can be quickly updated
• Escalate any care availability or customer service issues with provider offices to Supervisor for follow up
• Utilize internal and external resources to seek knowledge about insurance plans
• Send proactive messages to both patient and ordering/receiving providers about referral processing statuses
• Maintain productivity metrics and quality KPIs on a daily/weekly basis

Requirements

• Associate's Degree or medical assistant certification - Preferred
• High School Diploma or GED - Required
• 2 years of call center experience - Required
• Basic knowledge of insurance plans and requirements
• Knowledge of physician specialties and hospital services offered
• Knowledge of medical terminology - Required
• Bilingual in Spanish (conversation) - Preferred

Qualifications

• Successful completion of competency module (Level 2) upon hire - Required