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Referral Management Specialist

Lawrence , MA

Department
Intake
Job ID
11217
Schedule
Full Time
Shift
Day/Evening

Description

The Referral Management Specialist coordinates and processes entry of information received from referral sources via phone, fax, email, and online portals.  Communicates with referral sources regarding services provided and eligibility for Home Health Foundation services.  Facilitates timely and efficient referral processing.  Uses critical thinking to analyze and process referral information, as well as identify concerns that necessitate further information or warrant nurse review. Act as a resource to referral sources and the public.

Responsibilities:

  • Verifies that the necessary referral information (patient identification, medical, and financial information) is present to complete a referral for the admitting clinician to make the initial home health visit.
  • Accurately inputs data into the referral department “Request for Services” form within Forcura while on a call.
  • Creates case for all referrals in Forcura, assigns appropriate type, status, and priority tag.
  • Obtains insurance pre-certifications as required by insurer. 
  • Communicates with UR/billing to verify atypical insurances as requested by referral sources and to support UR and Clinical Staff.

Qualifications:

  • Medical paraprofessional with 2+ years in a medical office or home care experience, or  direct home health and hospice regulatory knowledge.
  • Certificate, training or equivalent working with medical terminology preferred.
  • ICD coding knowledge desirable, but not required

** ​​​​The hours for this position are 10:30am - 6:30pm with 1 weekend rotation every 4 weeks **

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