Lead Referral Coordinator - CST
Concentra Inc. - Lombard, IL

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JOB SUMMARY:
Processes referrals and authorizations for Concentra Medical Centers; acts as the primary associate responsible for colleague work process inquiries; works closely with physician(s)/physician(s) representatives, employers and payers to achieve a positive impact on the outcome cost and quality of care rendered to the injured employee, in accordance with Concentra policies, practices, procedures and applicable regulations.

The Lead Coordinator ensures the delivery of exceptional customer service by self and the center colleagues by putting all customers (internal and external) first and displaying:

A healing focus

A selfless heart

A tireless resolve

MAJOR DUTIES AND RESPONSIBILITIES:
Responds timely to Referral Coordinator process and procedure inquiries and acts as the first line of guidance on case level issues.

Works with and assist the Team Supervisor in the development of the daily meeting content including the day’s plan of action.

May be assigned to lead daily meetings or deliver pertinent information during the daily meeting.

Responsible for the daily completion of assigned market queues as outlined below.

Reviews/Processes all diagnostic/specialty/miscellaneous referral requests by Concentra Medical Centers.

Obtains authorization for referrals and schedules appointments as appropriate.

Assures referrals are maintained within appropriate networks/MSO’s.

Communicates with all stakeholders, payer, and employer, patient as appropriate and as per protocol.

Records all appropriate information via OA/CR module of OccuSource per Policy & Procedure.

Builds relationships with provider and payer community.

Reviews/Processes PT Authorization requests by Concentra Medical Centers.

Obtains authorization from payers for Physical Therapy as per protocol.

Provides all necessary information (medical records, scripts, etc) to payer.

Records all appropriate information via OA/CR module of OccuSource per Policy & Procedure.

Handles calls according to the call guidelines of the department.

Participates in quality assurance processes including the audit program, case reviews, training sessions and quality assurance as it relates to the phone system.

Provides special treatment and services for selected customers.

Provides one-on-one mentoring for new Colleagues.

Provide coverage for other markets and centers, when requested.

Other duties as assigned.

EDUCATION/CREDENTIALS:
High School diploma or equivalent.

JOB RELATED EXPERIENCE:
1-2 years referral, claims adjuster, telephone customer service, or related experience preferred.

JOB-RELATED SKILLS/COMPETENCIES:
Ability to communicate effectively, both written and orally.

Excellent customer service skills.

Ability to multi task in a fast paced environment.

Above average organizational skills.

Strong typing and computer skills.

WORKING CONDITIONS/PHYSICAL DEMANDS:
Office environment

This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.

Concentra's Data Protection Commitment
  • Concentra is committed to protect patient data and to ensure privacy of personal and medical information.
  • Every Concentra colleague has the responsibility to adhere to data protection principles.
  • If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.
Required Skills

1. Candidates must be internal
2. Candidates must be familiar with markets within the Northeast Zone
3. Candidates must not have received a PIP within the past six months
4. Candidates must be meeting current performance goals

Required Experience

Concentra Inc. - 14 months ago - save job - block
About this company
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Concentra Managed Care, Inc. is the leading provider of healthcare management and cost containment services to the workers' compensation,...