Referral Coordinator – Strawberry Wilderness Community Clinic | Full-Time

Shae

Why Blue Mountain Hospital District?

The Blue Mountain Hospital District (BMHD) is comprised of a Critical Access Hospital (CAH), Family Clinic, Home Health and Hospice, Emergency Medical Services, and a Care Center.  BMHD offers a wide range of services, one of them being General and Emergency Surgery.  Our Surgery Team is essential for our patients and serves the needs of many in our Rural community.  Join our family-like team in beautiful Eastern Oregon! Our District spans from John Day to Prairie City, nestled in the Heart of Grant County in the Blue Mountains.  The Strawberry Mountain Range and John Day River Valley offers a variety of outdoor activities, from abundant hiking/mountain biking/horse riding trails, to high and lower lakes and ponds.  Our area is known to be a “go to” place not just for recreation, but also for big game hunting and fishing! For more information on our Rural and Remote area, visit our Grant County Chamber of Commerce page at: https://www.gcoregonlive.com/

Position Summary:

  • The Referral Coordinator provide support to patients and providers in relationship to seeking prior authorization (PA) for medically necessary services (specialty care, ancillary and diagnostic services, select medications, and DME supplies) ordered by the provider.
  • Training new Referral Coordinator team members
  • Communication with providers regarding the processes and data required for prior authorization (PA).
  •  Oversees, produces and reports monthly metrics and status reports for the Prior Authorization/Referral functions to submit to Business Office (billing department requires management reports, trending/process changes to providers).
  • Participates in performance improvement and continuous quality improvement (CQI) activities.
  • The Referral Coordinator receives records and tracks all referred services sent from the provider base.
  • Requests are verified with the insurance carriers as to PA requirements.
  • When a PA is required, specifics of the request (service, related ICD-10, and chart notes are submitted to the carrier for consideration.
  • As needed the Referral Coordinator follows up with the ordering provider for clarification or additional information to submit the request.
  • Tracking of requests is recorded from the time of receipt to the time the service is completed and recorded in an established format to meet Meaningful Use (spread sheet) as well as to support accurate tracking of the referral for patient, staff and provider to follow.
  • This position follows up with patients as needed on the status of a referral.
  • Target – Non-urgent referrals are received and processed within 5 days; urgent or STAT referrals are process the same day.
  • Maintains self-motivation and sustains a high level of momentum.
  • Able to successfully prioritize when faced with requests, demands and deadlines.
  • Knowledge of customer service concepts.
  • Demonstrate ability to learn and maintain appropriate technical skills to effectively support the electronic record system and the needed MU tracking components in a timely manner.
  • Displays proficient understanding of ICD-10 (diagnosis) and CPT (procedural coding) as needed to support the process.
  • Displays the ability to demonstrate leadership, good interpersonal relationships and the application of sound principles.
  • Displays an understanding of the facility’s learning management system and keeping required education up to date.
  • Ability to communicate effectively, both oral and written through e-mail, presentations etc.
  • Is knowledgeable of equipment with basic computer skills, faxing, telephones and other department specific equipment.
  • Proficiency with Microsoft Word, Google Calendar, Gmail, Excel, PowerPoint, keyboarding, and reporting.
  • Completes orientation skill checklist assigned for departments.
  • Must be extremely detail oriented and able to perform accurate and thorough recordkeeping.
  • Proven ability to communicate effectively, both in written and oral form.
  • Ability to communicate effectively in English, both verbally and in writing.
  • Proven ability to work as part of a team, in a fast-paced production-oriented environment.
  • Ability to prioritize, highly organized.
  • Establish & maintain solid work relationships, through communication, cooperation, and positive interaction with all employees, staff and physicians.
  • Approachability – build rapport by making the effort to be cooperative and adaptive, put others at ease, and support co-workers.
  • Listening – practice active listening; display patience when listening to the views of others, and discuss differing opinions with an open mind.
  • Problem Solving work with others to prevent problems & find a solution when issues arise.
  • Effectively and consistently communicates administrative directives to personnel and encourages interactive departmental meetings and discussions.
  • Staff Meetings – Expected to attend departmental staff meetings and other meetings as required by administration.
  • Exhibit professional behavior while being caring and compassionate.
  • Consistently practices AIDET Principals to patients, staff and external customers and partners
  • Customer Focusdedicated to meeting the expectations of the internal & external customers. Demonstrate sensitivity, empathy, concern and respect for others. Act with the patient care in mind, gain trust and respect by building and maintaining effective relationships.
  • Maintain confidentialityin accordance with HIPAA regulations supports and safe guards the patient’s privacy.
  • Demonstrate sensitivity, empathy, concern and respect for others. Gain trust and respect by building and maintaining effective relationships.
  • Represents the organization in a positive and professional manner at all times.
  • Self motivated and contribute to new ideas.
  • Improvements – initiate improvements and apply new methods of working to help achieve goals.
  • Learning on the go develop an action plan when facing new problems, and be open to change.

Education Requirements:

Required:  High School Diploma or GED

Preferred:  Medical Terminology, CPT/ICD-10 coding
1-2 years of experience related to the position or in a Healthcare / Customer Service setting

Supervised by:

Director – Clinic Operations & Provider Relations

For more information, contact:

Shae Voigt, Coordinator – Human Resources
svoigt@bluemountainhospital.org  |  (541) 575-3820