Patient Referral Coordinator, San Antonio, TX, US ID#18285
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.
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:
The contract Referral Coordinator must demonstrate a working knowledge of professional standards and ethics regarding the delivery of care in a Virtual MEDCEN.
Demonstrate computer literacy sufficient to operate a personal computer utilizing word processing programs and possess basic typing skills sufficient to efficiently produce the Referral Coordinator’s own reports and correspondence.
Must have thorough and detailed knowledge of, and skill in applying, a comprehensive body of rules, procedures, and operations, such as 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.
Demonstrate working knowledge of medical terminology and management principles needed to implement daily work activities.
Demonstrate basic knowledge of and ability to apply data gathering methods and standardized processes and procedures. Also, must be able to identify and solve problems.
Demonstrate ability to communicate clearly, both orally and in writing, with various levels of personnel within the organization and with external organizations, to gather and analyze data, to present information, and to make recommendations based on findings.
Demonstrate knowledge of CHCS, AHLTA, VHCCA, CarPoint and Microsoft Access, Excel, Work, and PowerPoint.
Specific Task – Referral Coordinator
The contract Referral Coordinator shall perform the following functions within the scope of accepted industry practices. This list of tasks is not intended to establish either a maximum or minimum acceptable level of effort or be an inclusive listing of anticipated tasks. Referral Coordinator provided by the contractor shall perform essentially the same services as those required by any Army or government service Referral Coordinator professional of similar experience, in similar duty assignments and within their scope of practice.
The contract Referral Coordinator will be required to 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.
The contract Referral Coordinator will be required to participate in special event informational seminars as directed by the Commander VMEDCEN or his/her designated representative.
The contract Referral Coordinator will 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.
Enters 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.
Recognizes 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.
This position has the responsibility for coordinating, monitoring, tracking, 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.
When potential delays may compromise the patient’s condition, coordinates with appropriate medical authorities to find alternative sources of care. Contacts patients, if necessary, in the event the referral requests are invalid or disapproved and instructs patients on options.
Maintain patient privacy and confidentiality.
Keeps abreast of policy changes and current health care information and maintains pertinent records and files.
Provides information on covered health care services and services excluded from the program and how these benefits integrate with other health care sources.
Contractor’s personnel 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.
Consults with other individuals and organizations to include other hospital services.
Provides 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 Integrates 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.
Other duties as assigned.
No supervisory/management authority.
EDUCATION 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 will be performed primarily in a climate-controlled office environment
About Cherokee Federal
Cherokee Federal – a division of Cherokee Nation Businesses – is a team of tribally owned federal contracting companies focused on building solutions, solving complex challenges, and serving the nation’s mission around the globe for more than 60 federal clients. Our team of companies manages nearly 1,000 projects of all sizes across the construction, consulting, engineering and manufacturing, health, and technology portfolios.
Since 2012, the Cherokee Federal team of companies has won more than $5 billion in government contracts. Our 3,000+ employees work in 26 countries, 50 states and 2 U.S. territories.
Why choose Cherokee Federal? Visit our website and learn about the great reasons to join our team. cherokee-federal.com
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; https://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf and https://www.dol.gov/ofccp/regs/compliance/posters/pdf/ofccp_eeo_supplement_final_jrf_qa_508c.pdf
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 e-mail 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; https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
We maintain an Affirmative Action Plan for 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: 2020 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.