Referral Specialist/Care Coordinator

Duties/Responsibilities:

• Partner with ArchWell Health’s multi-disciplinary care team to gain a deep understanding of each member’s care needs, including identifying gaps and barriers to treatment
• Coordinate referrals to external providers, vendors, and services to ensure care needs are met
• Complete proper documentation for member referrals to ensure records are accurate and current
• Build and nurture relationships with members and their families to successfully facilitate care coordination
• Carry out all activities and provide ongoing monitoring as outlined in a member’s care plan to ensure routine followup and progression is made on care plan goals
• Adhere to HIPAA standards and confidentiality of protected health information (PHI)
• Promote clear communication among care team and treating clinicians to ensure positive member outcomes
• Assist members in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
• Be the system navigator and point of contact for members and families, with patients and families having direct access for asking questions and raising concerns.
• Additional duties, as assigned

Required Skills/Abilities:

• Deep understanding of the healthcare ecosystem, ideally with experience in benefits and insurance authorization
• Passion for helping senior members successfully carry out care plans
• Ability to work effectively with diverse populations including staff, providers, members, family members, insurance carriers, vendors, and the public
• Basic medical terminology
• Understanding of Medicare criteria for equipment and supplies
• Knowledge of CPT and ICD-10 codes
• Working knowledge of specialists and community resources to assist the member
• Strongcommunication and rapport-building ability among an interdisciplinary team
• Ability to multi-task and manage competing prioritieswith high attention to detail
• Proficient PC skills to include Microsoft Office
• fluency in Spanish, or languages spoken by the people in thecommunities we serve (where necessary)

education and Experience:

• H.S. Diploma or equivalent required; degree or college level coursework in healthcare preferred
• 2 years of experience in referral management or care coordination
• Medical Assistant or medical administrative experience is helpful
• Experience with EMR systems, ideally eClinicalWorks or similar