Referral Management Clerk - Healthcare

Description

• Hourly Pay:$18.50 - 20.00 per hour
• Health & Welfare Fringe Benefit:$5.09 per hour
• Paid Time Off:10 days annually (based on 8-hour days)
• Paid Holidays:11 days per year
• Paid Sick Leave:Accrues at 2.154 hours per 80 hours worked
• 401(k):Company-funded match and Safe Harbor
• Medical, Dental, and Vision Plans Available
• Life Insurance and Accidental Death Coverage
• Short- and Long-Term Disability Plans
• TRICARE Supplemental and Additional Benefit Plans
• Employee Assistance Program
• Pet Insurance Plans
• Will Preparation Services

Referral Management Clerk Job Overview

• The Puget Sound Military Appointing Center (PSMAC) is a centralized services center that serves as the primary point of contact for PSMHS beneficiaries for PAS, RMS, and CLRS as they seek healthcare services, and is therefore a critically important resource in our healthcare delivery system.
• Call center that manages inbound and outbound calls from beneficiaries, validates beneficiary eligibility, schedules, cancels, and reschedules patient appointments in order to provide timely access to quality healthcare.
• Provide outbound calls in order to schedule specialty appointments for beneficiaries who have received a direct care specialty referral.
• RMS processing supports the timely scheduling of specialty care referrals ordered by MTF HCPs.
• RMS services span a range of functions to include, but not limited to: identifications of specialty referrals to be deferred to the network, ensuring processing in accordance with DHA timeliness, and tracking status of network referrals.
• Review of each MTF generated referral and determining a disposition as either "Appoint to MTF" or "Defer to Network (DTN)" based on specific MTF specialty clinic capabilities, capacities, and DHA access to care standards.
• Maximizing the retention of specialty care within the MHS to support the readiness of the Medical Force, within capability and capacity parameters.
• Additional contracted services include processing Secure Message Service (SMS) transmittal requests for appointments, drive-time mapping capabilities in support of specialty care appointing, as well as outbound letters to beneficiaries referred for MTF specialty care.

• Disposition all routine referrals as either Appoint to MTF, Defer to Network, or route to MTF Referral Management Center (RMC) IAW standardized PSMHS business policy.
• Document and report complaints received, errors found, and the specific corrective action taken by the contractor. Errors shall include those identified by patients/beneficiaries, clinic and/or MTF staff, and direct to the contractor.
• Process incoming referrals (ROFR) from the MCSC network providers and MTFs according to eMSM, DHA requirements and standardized guidelines.
• Record and track status and disposition on all Prime/Select/VA/ ROFRs, MTF, and network referrals and communications received, per DHA and PSMHS business rules.
• Review all referrals and appoint to MTF referrals, or return to requester based on policies and procedures.
• Provide Monthly Reporting

• High school diploma or General Educational Development (GED) equivalency
• Skilled in Word, Excel, Access, and other software programs
• Excellent communication, interpersonal and customer service skills
• Able to define problems and obtain solutions
• Must be able to obtain clearance to access the work site and be granted a Common Access Card (CAC).
• Must be able to clearly communicate, verbally and written with coworkers and clinic staff.
• Healthcare administrative experience - preferred
• Ability to obtain facility security