Health Plan Operations Lead for Referrals & Compliance

Pacific Medical Centers Corp; Renton (WA); On-site; USD 90,000 - 120,000; Full time

Job summary

Pacific Medical Centers (PacMed) is seeking a leader to organize and direct the Referrals and Referral Support Staff under the USFHP Operations Director. You will ensure accurate data entry and timely processing of authorizations and referrals, while upholding DoD guidelines and contract requirements.

You will set referral policies, monitor compliance, and educate staff on Medicare/TRICARE guidelines. You will participate in budget management with the USFHP leadership team and collaborate with

Qualifications

• 4 years health care referrals experience.
• 2 years supervisory capacity, including Lead role, or 6 months supervisory experience within a healthplan.
• Bachelor's degree in Health Care Administration or Business Administration preferred.

Responsibilities

• Organizes and directs the daily activities and department workflow of the Referrals and Referral Support Staff under the supervision of the Director of USFHP Operations.
• Ensures accurate and timely data entry and processing of authorization and referrals of Pacific Medical Centers' revenues and expenses for Outside e (OPS).
• Assures compliance with DoD and other government agency guidelines and contract requirements.
• Sets Referral policy and monitors compliance to same.
• Monitors Medicare and TRICARE referral guidelines and educates staff in changes.
• Identifies and solves processing issues with outside providers.
• Serves as a member of the US Family Health Plan management team.
• Jointly manages the US Family Health Plan budget with the Director of USFHP Operations and the other members of the management team.

Skills

Referrals experience

Supervisory experience

Data entry accuracy

Policy compliance

Medicare/TRICARE knowledge

Education

Bachelor's degree in Health Care Administration or Business Administration

Job description

Pacific Medical Centers (PacMed) is seeking a leader to organize and direct the Referrals and Referral Support Staff under the USFHP Operations Director. You will ensure accurate data entry and timely processing of authorizations and referrals, while upholding DoD guidelines and contract requirements.

You will set referral policies, monitor compliance, and educate staff on Medicare/TRICARE guidelines. You will participate in budget management with the USFHP leadership team and collaborate with