POSITION PURPOSE:

Coordinate referral authorization process between the provider and the insurance plans. Initiate preventive and Health Risk Assessment, Assisting clients with request for transfer to CHI as their Primary Care Provider. Provide Clients with general information regarding benefit coverage.

POSITION REQUIREMENTS / QUALIFICATIONS:

Education/Experience:
High School or GED equivalent. Graduate from an approved Medical Assistant Program (in the state of Florida or any other State) preferred. Two to Three years of experience in related area may substitute for Medical Assistant Certification.

Licensure / Certification:
Certified Medical Assistant (CMA), Registered Medical Assistant (RMA), desired. Maintain current CPR certification from the American Heart Association.

Skills / Ability:
Medical Terminology, Keyboard, Knowledge of Medicaid coverage benefits/limitations, knowledge of HMO contracts, and knowledge of ICD10 and CPT Codes. Working knowledge of managed care utilization, authorization process Basic computer knowledge. Must type a minimum of 20 – 30 WPM. Bilingual skills (English/Spanish, English Creole) desired.

POSITION RESPONSIBILITIES (THIS IS A NON-EXEMPT POSITION)

Process authorization request for emergency treatment, specialty and ancillary services for managed care enrollees.

Ensure referral request forms are accurately completed and processed in a timely manner.

Enter referral authorization in computer system for all clients enrolled in HMO.

Complete a minimum of thirty (30) referrals per day, working on the front end.

Respond to telephone inquiries regarding coverage and benefits, appointment, referrals, etc. from clients, insurance companies, personnel and providers.

Schedule appointments with health care providers (specialist and diagnostic Centers.

Managed Care Tech will create, and submit at the end of each day, a Daily Productivity Log in the form provided by CHI, the date of a referral on the Referral Letter must match the date on your Daily Productivity Log.

Participate in Performance Improvement Activities.

Participate in appropriate continuing education in service training.

Maintain current licensure and/or certificates.

Assist clients with request for transfer to CHI for their Primary Health Care needs.

Maintain logs of referral request and prepares monthly activity report.

Request consultation report from specialist and other health care providers to whom patients are referred.

Ensure copies of consultation report received from external are forwarded to referring doctor and Health Information Management.

Request supporting document for referral request from providers when requested by Managed Care Organizations.

Assist in obtaining authorization for primary specialty and ancillary services within CHI communicating with appropriate staff regarding authorization received.

Maintain roster of all patients assigned to CHI by Managed Care Plan.

Maintain record of admission of all CHI assigned patients.

Adhere to department Policies and Procedures in performing duties and assignments.

Demonstrates the ability to work with a diverse population.

Reports to work on time and ready to work with minimal absenteeism.

Adheres to Confidentiality Policies and Procedures / HIPAA Regulations.

Adheres to AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You).

Performs other duties as assigned.