Referral Specialist I

The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction. ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state. Our vision: Alaska Native people are the healthiest people in the world.

Benefits

• Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers
• Cost-Share Dental and Vision Insurances
• Discounted Pet Insurance
• Retirement Contributions with Pre-Tax or Roth options into a 403(b)
• 401(a) ANTHC Retirement Plan: After one year of employment, ANTHC will begin making matching contributions of up to 5% of your eligible pay, based on your own contributions. In addition, you may be eligible for an annual discretionary contribution of up to 3% from the employer
• Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service
• Eleven Paid Holidays
• Paid Parental Leave or miscarriage/stillbirth eligibility after six months of employment
• Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members
• Flexible Spending Accounts for Healthcare and Dependent Care
• Ancillary Cash Benefits for accident, hospital indemnity, and critical illness
• On-Site Child Care Facility with expert-designed classrooms for early child development and preschool
• Employee Assistance Program with support for grief, financial counseling, mental/emotional health, and discounted legal advice
• Tuition Discounts for you and your eligible dependents at Alaska Pacific University
• On-Site Training Courses and Professional Development Opportunities
• License and certification reimbursements and occupational insurance for medical staff
• Emergency Travel Assistance
• Education Assistance or Education leave eligibility
• Discount program for travel, gym memberships, amusement parks, and more

Responsibilities

• Monitor the Electronic Health Record (EHR) notifications and established referral systems throughout the day to capture, process, and document internal and external medical referral requests according to standard operational procedures
• Reviews referrals for completeness and follows up for additional information if necessary
• Gathers pertinent information, including patient demographic and clinical information such as eligibility, health screening, insurance status, medical priority, referring service and provider(s), and purpose of referral
• Accurately completes referrals within established timeframes and provides status of the request to the referring service
• Communicate with referring service, case manager, health benefits team, or central registration team for any identified issues and/or requirements
• Responds to inbound calls initiating exam requests following established processes, meets quality and productivity standards
• Acts as a liaison between ANTHC and Tribal Health Organization partners and provides referral statuses (e.g., scheduled, seen, on-hold, etc.)
• Performs other duties as assigned

Requirements

• Knowledge of applicable federal, state, and tribal healthcare programs
• Knowledge of state, federal, and public/private insurance carrier regulations including Centers for Medicare and Medicaid
• Knowledge of general medical terminology, anatomy, physiology and concepts of diseases
• Knowledge of ICD-10 and CPT coding
• Knowledge of the Privacy Act of 1974 and HIPAA Privacy Rule Act of 1966
• Skill in customer service with strong communication skills using the telephone and electronic media
• Skill in operation of a personal computer utilizing various software including electronic health records and on-line application processes
• Skill in assessing and prioritizing multiple tasks, projects, and demands
• Skill in written and oral communication

Qualifications

• High school diploma or GED equivalent
• One (1) year professional work experience in a clinical setting; OR one (1) year experience in medical referrals, or other related medical patient support function in a clinical setting
• An equivalent combination of relevant education and/or training may be substituted for experience