Referral Specialist - Care Coordination - Behavioral Health

Davita Inc.; Peoria (IL); On-site; USD 10,000 - 60,000; Full time

Job summary

A leading healthcare company is looking for a talented individual to manage their behavioral health call center operations. The role includes coordinating patient appointments, obtaining necessary authorizations, and ensuring high levels of customer service. The ideal candidate will have experience in the behavioral health field, strong communication skills, and a commitment to patient care.

Qualifications

• 2-3 years experience in behavioral health care.
• Fluent in English, written and verbal communication.
• Ability to work as a team member.

Responsibilities

• Manage behavioral health referral processes and scheduling.
• Obtain pre-authorizations and coordinate patient appointments.
• Serve as a liaison with referral sources and maintain EMR documentation.

Skills

Strong telephone skills

Organizational skills

Multicultural sensitivity

Customer service focus

Critical thinking skills

Tools

Microsoft Office

Job description

Overview

Manage all facets of the behavioral health call center and behavioral health referral process. The scope of the screening and scheduling process begins with prompt management of the initial consumer or referent inquiry through to the scheduling an appointment with the best location of service at Unity Place. Responsibilities include, but are not limited to, answering incoming behavioral health calls being sensitive to patient's characteristics and needs, obtaining pre-certification or prior authorizations, scheduling the initial service appointment with specialist or outpatient services, completion of documentation with the electronic medical record (EMR) and communicating referral information to referring offices and to the consumer.

Qualifications

Educational Requirements

Certification & Licensure Requirements

• Use of usual and customary equipment used to perform essential functions of the position. Upon Hire

Experience Requirements

• 2-3 years previous experience in behavioral health care field.

Other Requirements

Strong telephone and organizational skills and ability to interact effectively with internal/external customers. Writes, reads, comprehends and speaks fluent English. Multicultural sensitivity. Microsoft Office - basic computer skills. Customer/patient focused. Critical thinking skills using independent judgment in making decisions. Ability to work as a team member. Ability to understand and apply guidelines, policies and procedures.

Responsibilities

Assessment and Coordination of Patient Appointments & Authorizations

• Basic understanding of symptoms, causes, and treatment of mental health, addiction, and substance use problems to identify the proper location that best fits the consumer's needs and insurance coverage.
• Consistently answers the phone according to established call center metrics.
• Knowledge of assessment process and how to use referral lookup to find results based on consumers need.
• Coordinates appointments and relays authorization information to scheduling staff of location of service, as requested.
• Schedules patients accurately in a timely and polite manner to ensure customer satisfaction.
• Completes HCPC and SUPR coding.
• Provides appropriate and timely documentation in the patient's EMR using standardized workflows and processes.
• Builds and maintains positive working relationships with all contacts
• Acts as a liaison between Unity Place and all referral sources

Obtain Pre-Certifications and Prior Authorizations Services

• Obtains insurance pre-certifications and prior authorizations for scheduled services including assessment, testing for patients.
• Coordinates pre-certs and authorization processes with scheduling staff so appointments can be made in timely manner.
• Obtains any and all pertinent clinic health information from provider, clinical staff and/or EMR to process authorizations, referrals, and pre-certifications.
• Verifies demographic information, including insurance, when scheduling and/or obtaining pre-certifications.
• Monitors outstanding authorization requests and initiates follow-up of outstanding authorizations in a timely manner.
• Maintains current knowledge of payer specific requirements of prior authorizations by attending virtual workshops, researching, and reading newsletters.

Correspondence with Patients

• Notifies patient of appointment details via telephone, MyChart, and letter.
• Active listening and evidenced based practices (motivational interviewing, community reinforcement approach, and skills training)
• Ensures patients are scheduled in first available appropriate appointment and location.
• Reinforces instructions to patient per protocol.
• Utilizes exemplary customer service skills with every patient interaction
• Suicide assessment: can demonstrate appropriate utilization of Suicide Assessment scale and make appropriate emergency referral.
• Ability to gather information to gain understanding of individual's current situation and history to make an appropriate judgment on treatment location and patient's readiness for treatment.
• Independently handles communication in a manner that decreases conflict and demonstrates courteous, respectful and caring behavior with sensitivity towards consumers.

About Us

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [e-mail].

Compensation and Benefits

The compensation range for this position is $18per hour - $29.13per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate's experience, qualifications, location, training, licenses, shifts worked and compensation model.
Carle Health offers a comprehensive benefits package for team members and providers. To learn more visit careers.carlehealth.org/benefits.