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Role Description

Reporting directly to the Halmark Health PHO (HHPHO) Central Services Manager, this role is responsible for “navigating” patients through our healthcare system by scheduling appointments with specialists at the point of contact to provide expedited and convenient service.

• Handles all inbound calls, requests, and processes all insurance referrals for Hallmark Health PHO (HHPHO) & Lowell General Hospital PHO (LGPHO) Primary Care Providers (PCPs).
• Communicates regularly with Primary Care Provider (PCP) and Specialty Provider offices and maintains relationships with Emergency Departments and affiliated Urgent Care Centers.
• Follows the HHPHO/LGPHO referral guidelines and works with the PCPs, PHO Medical Directors, office staff, and the patient to help direct care to a specialist within the TuftsMedicine network.
• Supports PCP offices by making outreach calls to help improve the Quality Measures/Scores of patients.

Qualifications

• High School graduate or equivalent.
• One (1) year of health care experience in patient registration or physician office.

Requirements

• Three (3) years of health care experience in patient registration or physician office (preferred).

Benefits

• Competitive salaries & benefits that start on day one.
• 403(b) retirement with company match.
• Tuition reimbursement.
• Free on-campus parking.
• Career growth opportunities.
• Guaranteed hours and set schedule.

Job Description

• Responsible for maintaining relationships with Emergency Departments and affiliated Urgent Care Centers.
• Handles all inbound calls and requests for the Provider Finder Line program.
• Follows the HHPHO/LGPHO referral guidelines and works with the PCPs, PHO Medical Directors, office staff, and the patient.
• Supports PCP offices by making outreach calls to improve Quality Measures/Scores.
• Utilizes effective customer service etiquette and skills in all phases of communication.
• Responds immediately to patients or PCPs requesting specialist appointments.
• Tracks number of appointments made and alerts Manager regarding appointment access issues.
• Maintains excellent rapport and ongoing communication with physician office staff, providers, and co-workers.
• Maintains a basic knowledge of insurance referrals, eligibility, and prior-authorizations.
• Confirms eligibility of the member being referred/scheduled.
• Processes referral requests via insurance websites and enters them into the patient’s Electronic Medical Record (Epic).
• Processes paper referrals for those insurance plans that do not have electronic capabilities.
• Schedules appointments and processes referral requests via various communication methods.
• Communicates with patients the reason for the re-direct in care.
• Communicates with PCPs regarding possible redirection of out-of-circle referrals.
• Communicates with the Medical Director to review any referral request approved by the PCP.
• Follows established HHPHO/LGPHO guidelines regarding all out-of-circle referrals.
• Assists PCPs in processing out-of-state referrals based on insurance guidelines.
• Utilizes TigerConnect to reach out to patients and communicate with other providers.
• Delivers office marketing materials when needed.
• Occasionally attends meetings to give status updates on call volume and other relevant topics.
• Assists with the daily operations of the Managed Care Department and the PHO as needed.
• Maintains a level of professional knowledge regarding the rules of insurance referral standards.

Pay Range

$20.12 - $25.15