Referral Management Administrative Clerk – MacDill AFB, FL

Reef Systems; Tampa (FL); On-site; USD 10,000 - 60,000; Full time

Job summary

An established industry player is seeking a Referral Management Administrative Clerk to support vital healthcare operations at MacDill AFB, FL. This full-time, on-site role is crucial for ensuring seamless patient referrals and managing healthcare information systems. You'll engage with patients, provide education on specialty care, and collaborate with clinical staff to enhance operational efficiency. Join a dedicated team that plays a pivotal role in delivering quality healthcare services to military beneficiaries. If you are detail-oriented, possess strong administrative skills, and are passionate about healthcare, this opportunity is perfect for you.

Qualifications

• Fluent in English with general office and clerical skills.
• Two years of healthcare administrative experience preferred.

Responsibilities

• Support RMC operations and manage patient referrals accurately.
• Educate patients and clinical personnel about referral processes.

Skills

General office administrative skills

Clerical skills

Operational computer skills

Customer service skills

Medical ethics

Telephone etiquette

Education

High school diploma or GED

Healthcare administrative experience

Tools

Microsoft applications

MHS GENESIS

CHCS

AHLTA

HAIMS

RMS ICD-B

Job description

Referral Management Administrative Clerk – MacDill AFB, FL

Reef Systems has an immediate need for a Referral Management Administrative Clerk to support the Air Force medical Service (AFMS) mission at the Referral Management Center (RMC) located at MacDill AFB, FL. This is a full-time, on-site position.

DESCRIPTION OF SERVICES

Background

The Air Force Medical Service (AFMS) operates and manages a worldwide healthcare system to deliver medical service for more than 2.63 million eligible beneficiaries. Beneficiaries include active duty, family members, and retirees, during both peacetime and wartime. The AFMS responds to a full spectrum of anticipated health requirements and provides an integrated healthcare system from forward deployed locations through definitive care with an emphasis on prevention of illness and injury. Each referral is coordinated through a process called Referral Management (RM). When specialty care is referred, the Referral Management Center (RMC) is responsible for advising the patient of their benefit and working with the referring provider and the Managed Care Support Contractor (MCSC) to ensure that the referral is accurate. The RMC is also responsible for coordinating the referral with the specialty office, facilitating the recapture of Medical Treatment Facility (MTF) direct care capabilities, tracking the referral to closure, and returning all results of treatment to the patient’s medical record.

Scope

The Contractor shall support the AFMS’ mission of staffing and managing RMCs at the MTFs, serving as the one-stop shop for all referrals from the initiation of a referral to receipt of a clear, legible, Health Insurance Portability and Accountability Act (HIPAA) compliant report is returned to the MTF.

SUMMARY OF REQUIREMENTS

Referral Management Center (RMC) Operations:

• Operate the RMC at the MTFs listed within Appendix A. Support RMC operations and provide referral management services to patients during normal MTF business hours for telephonic, electronic, and in-person access.
• Process and review referrals in Government information systems including, but not limited to: MHS GENESIS, CHCS, MCSC referral systems, AHLTA, HAIMS, and RMS ICD-B programs.
• Accurately refer patients to subsequent care using the most current MTF Capabilities Report, and the Access to Care (ATC) standards and RMC Business Rules.
• Initiate, follow, manage, and close all referrals within timeliness standards identified in the TRICARE Operations Manual and other current Government policies.
• Provide patient education regarding specialty care referral and prepare the patient for their specialty care appointment.
• Provide MTF clinical personnel education concerning referral process and timelines, no less than semi-annually.
• Identify and notify the Government MTF case manager or PCM team of any patient that may benefit from care management.
• Sustain and follow the most current MTF Specialty Clinic Booking Guidance and MTF/MCSC Memorandums of Understanding.
• Participate in inspections by providing any requested referral management information.

Referral Review/Appointing Function:

• Review initial specialty care and deferred-to network primary care referrals for administrative completeness.
• Verify patients are registered in CHCS and DEERS; update demographic and other pertinent information.
• Determine patient eligibility for services and schedule specialty referral appointments using established protocols.
• Assist with ROFR determinations for specialty care that can be provided within the MTF.
• Document patient appointments in approved AFMS system(s).
• Process ROFRs within the time limits outlined in the TRICARE Operations Manual.
• Accept/decline urgent and routine priority ROFRs within specified time frames.

Referral Tracking Function:

• Track and obtain initial specialty care and deferred to Network primary care referrals.
• Retrieve CLRs no later than 180 calendar days after the order entry date.
• Import/scan CLRs into the correct patients’ medical record within three business days from receipt.
• Follow-up with MTF specialty care providers who did not complete CLR referral results.
• Provide the referring providers a monthly list of their referred patients who have not scheduled their initial specialty care appointment.
• Prepare referral management data reports/metrics.

Minimum Education and Experience Requirements:

• Shall read, understand, speak, and write English fluently.
• High school diploma or GED equivalency.
• General office administrative and clerical skills.
• Operational computer skills with knowledge of Microsoft applications.
• Preferred two years of healthcare administrative experience.
• General medical ethics, telephone etiquette, and customer service skills.

Basic Life Support Certification:

At a minimum, any Contractor personnel working within an MTF must maintain current certification in the American Heart Association Basic Life Support (BLS) or the American Red Cross CPR/BLS (Heart Saver) Course.

Place of Performance:

Work will be accomplished on-site at MacDill AFB, FL.

Available Hours of Operation:

The Contractor shall provide Referral Management Services during normal MTF operating hours, from 7:30 AM through 4:30 PM, Monday through Friday, excluding federal holidays.

Scheduled Holidays:

New Year’s Day; Dr. Martin Luther King, Jr. Birthday; President’s Day; Memorial Day; Juneteenth; Independence Day; Labor Day; Columbus Day; Veteran’s Day; Thanksgiving Day; Christmas Day.