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Patient Referral Coordinator- San Antonio, TX (ID# 15458)

When your mission depends on quality health care, rely on a team who can deliver results. From cutting-edge analysis to optimized health programs, Cherokee Nation Healthcare Services (CNHS) can manage any size federal project. Federal clients who partner with CNHS improve their access to care, medical readiness and program efficiency. Wherever the mission takes you, CNHS delivers world-class solutions, on time and on budget.

For more company information, visit our site at http://cherokee-cnhs.com/Pages/Home.aspx

SUMMARY

The Patient Referral Coordinator will assist the SAMMC Virtual Med Center Support Services in providing referral coordination within a clinical setting.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Includes the following:

  • Attend and participate in meetings and professional staff conferences and other appropriate professional activities such as, but not limited to the following: Quality Improvement meeting, professional staff meetings, Department meetings, and others required by applicable regulations, MTF guidance, or as directed by the Commander, Virtual MEDCEN or his/her designated representative.
  • Participate in special event informational seminars
  • Provide assistance and monitoring to eligible beneficiaries by reviews, coordinates, and tracks Virtual Healthcare referrals, urgent/ASAP referrals, and VA-DOD sharing referrals. Serves as the focal point for the coordination of health care services through reviewing of covered benefits, conducting CHCS and DEERS eligibility checks, ensuring administrative completeness, and monitoring, maintaining and tracking of referrals.
  • Enter in database system documentation on processing/research of each referral and status of each referral. Assists physicians with proper documentation and preparation of required forms. Serves as intermediary between the BAMC physicians, patients, and outside health care agencies and individuals in arranging for services and obtaining the necessary consultations and required authorizations.
  • Recognize potential problems and assists in the resolution of problems between patients, providers, and clinics and the Medical Treatment Facility (MTF). Receives all external referral requests, coordinates with MTF staff and vendors for sources of service. Through patient interviews, referrals and/or consultation with medical staff and conducting extensive research coordinates patient referrals to appropriate sources for care and/or other assistance. Locates medical care requested which is not available in the MTF. Coordinates and/or obtains necessary documents for exceptions. Electronically transmits consults to the Managed Care Support Contractor (MCSC) when appropriate.
  • Coordinate, monitor, and track health care referrals for the beneficiary population, to include Active Duty, Tricare Prime, Tricare Standard, Tricare for Life, and Tricare Plus, VA-eligible and MEDICARE.
  • Contacts patients, if necessary, in the event the referral requests are invalid or disapproved and instructs patients on options.
  • Maintain patient privacy and confidentiality.
  • Keep abreast of policy changes and current health care information and maintains pertinent records and files.
  • Provide information on covered health care services and services excluded from the program and how these benefits integrate with other health care sources.
  • Provide office automation support and production. Contractor’s personnel uses knowledge of the capabilities, operating characteristics and advanced functions of a variety of different software types to improve the efficiency and/or effectiveness of office operations. Contractor personnel maintain electronic and paper files of information for later retrieval as appropriate.
  • Consult with other individuals and organizations to include other hospital services.
  • Provide reports and identifies trends, problems and shortages of specialty care to the supervisor. Assists the supervisor with preparing monthly statistical data of overall review process for higher management.
  • Integrate data from various types of software, including CHCS, AHLTA, and Microsoft Access, Excel, Work, and PowerPoint. Responsible for collecting maintaining and tracking referrals using an automated External Referral Access database.
  • Performs other job related duties as required.

SUPERVISOR/MANAGEMENT AUTHORITY

  • No supervisory/management authority.

EDUCATON AND EXPERIENCE

  • High School graduate, college graduate preferred. Working knowledge of professional standards, ethics and medical terminology

KNOWLEDGE, SKILLS AND ABILITIES

  • Excellent written and oral communication.
  • Accuracy and attention to detail.
  • Skilled in Microsoft Office Word, Excel, PowerPoint, CHCS, and AHLTA.
  • Must have thorough and detailed knowledge of, Army ambulatory care medical records activities, operations, and regulations; medical terminology, procedures, anatomy, physiology, and disease processes; ICD-9-CM/ICD-10-CM diagnosis, CPT procedural, evaluation, and management, and HCPCS (Health Care Financing Administration’s Common Procedure Coding System) coding techniques; and Ambulatory Data Module (ADM) computerized data entry.

WORK ENVIRONMENT

Work will be performed primarily in a climate controlled office environment

Applicants selected will be subject to a U.S. Government security investigation and must meet eligibility requirements for access to classified information.

We are an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected Veteran status, gender identity and sexual orientation. If you’d like more information about your EEO rights as an applicant under the law, please copy and paste the links to the following two sites: EEO Statement | EEO Poster

If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may email “CNB.Compliance@cn-bus.com” for assistance. This email address is for accommodation requests only and cannot be used to inquire about the application process or status.

For Pay Transparency Non Discrimination provision, please copy and paste the following link: Pay Transparency Nondiscrimination Provision

We maintain an Affirmative Action Plan for the purpose of proactively seeking employment and advancement for qualified protected veterans and individuals with disabilities. Upon request, we will schedule time to make our Affirmative Action Plan accessible. If you are interested, please submit a written request with the email subject line: 2018 Request to View Affirmative Action Plan to the Compliance Administrator at “CNB.Compliance@cn-bus.com” This email box is not for resumes or follow up on job applications.