Associate Referral Representative

The Associate Referral Representative is responsible for processing patient referrals and prior authorizations. Educates the patients on various procedures and benefits, related to the need for referrals. Coordinates referrals with patients and specialist's offices, and process insurance referrals as required. Acts as a liaison between patient, physician, and insurance company, consistently performing activities in a friendly, courteous, and professional manner. Assists patients over the phone using the call center representative standards.

EXPECTATIONS

Every Adelante employee will strive to maximize their performance and contribution to Adelante Healthcare and the community we serve every day. Employees are expected to work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism and competence.

OUR CORE VALUES

• Compassion
• Excellence
• Integrity
• Learning
• Respect
• Sustainability

ESSENTIAL SKILLS AND EXPERIENCE

• Effective verbal and written communication skills and has a professional presence
• Ability to communicate effectively with patients, co-workers, and the public both in person and over the phone

• 0-1 year of medical referral experience and 1 year of customer service experience.
• Knowledge of medical terminology
• Accuracy and attentional to detail
• Ability to prioritize and perform multiple tasks simultaneously
• Must possess strong organization skills
• Be able to work independently and within a team
• Knowledge of MS Office: Particularly Excel, Word, and Outlook
• Computerized database experience
• Effective office skills: typing, faxing, scanning and telephone
• High school diploma or GED from an accredited institution
• Commitment to Adelante Healthcares mission, vision, and values
• Willingness to be cross-trained and learn new skills and responsibilities

• Valid Level One Fingerprint Clearance Card issued by the Arizona Department of Public Safety for all specialty behavioral health locations

NONESSENTIAL SKILLS AND EXPERIENCE

• Experience in community health

POSITION REPONSIBILITIES/ESSENTIAL

• Responsible for scanning incoming documents into patients charts accurately
• Sort incoming faxes and correspondence
• Research and verify within patients chart
• Ability to perform work at established production rates
• Maintain effective communication with office staff and providers in all the health centers as needed
• Demonstrates respectful and professional behavior that supports a team-oriented work environment
• Attend staff meetings, in-service meetings, or other required meetings
• Maintains satisfactory attendance, is punctual and works full scheduled shift
• Meeting minimum standards of metric expectations

Additional Duties and Responsibilities

• Other duties as request or assigned

PCMH

All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team based model to promote wellness and improve health outcomes.

Adherence to Compliance and Code of Conduct

All employees are required to comply with Adelante Healthcares written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelantes legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance, and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.