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Job Field: Legal Jobs
Location: MURRAY, UT
Job Type: Full Time

JOB SUMMARY:

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Referral Services Specialist Job ID: 131804 Greater Salt Lake area Details: About Us What does it mean to be a part of Intermountain Healthcare? It means that the quest for clinical excellence is not just a goal, but a given. It means building an environment where physicians and employees can deliver the best in medicine. And itamp;rsquo;s realizing each employee or volunteer is vital to the healing process, because we can only achieve theextraordinarytogether. Being a part of Intermountain Healthcare means joining with a world-class team of over 32,000 employees and embarking on a career filled with opportunities, strength, innovation, and fulfillment. Our mission is: excellence in the provision of healthcare services to communities in the Intermountain region. Our patients deserve the best in medicine, and we deliver. Job Description Help members find appropriate care by advising them on the different types of care provided by physicians, dentists, facilities and other medical professionals. Advocates triage for access, directs callers to the proper place for care, and screens for potential access problems. Job Essentials * Takes inbound calls from members requesting help finding a physician. Gathers office and clinical information from providers to help guide members to the provideramp;rsquo;s practice. Guides members to use participating providers on their health plan and guides them to the appropriate place for their care. * Prepares the member for their office visit by helping them understand how to use their health insurance. * Provides information and advises when a patient or physician requests care from a provider who does not participate with the memberamp;rsquo;s plan. While following company guidelines, helps facilitate patient access to care with one of these providers. * Prepares for reviews by gathering medical records from providers the member has already seen. If not able to approve the request, may send it to the Utilization Management Department. * Makes outbound calls for compliance with NCQA guidelines upon request. * Coordinates member needs with Member Services, Care Management, Provider Relations, Marketing / Sales, Appeals and Pharmacy. * Complies with established auditing criteria. Stays current and conversant on general plan design and modifications to provide accurate and appropriate information * Educates callers on which physicians are on their plan and coordinates acquiring benefit information from a customer service representative. Makes exception / empowerment decisions within the established exception policy. * Follows established guidelines to complete pre-notifications/pre-certifications for members and providers for Failed Access. Entry Rate: $12.69 Benefits Eligible:Yes Minimum Requirements * Two or more years customer service experience * Intermediate knowledge of word processing programs and data entry Physical Requirements * Manual dexterity, hearing, seeing and speaking Preferred Qualifications * Medical terminology or medical background * Confident in learning new systems and databases * Demonstrated strong problem-solving skills, effective time management skills, and excellent communication skills essential for direct provider and staff interaction * Maintain confidentiality and exercise good judgment * Self-starter, requiring minimal supervision * Professional and enthusiastic * Able to develop and maintain a positive interface with the physicians, staff members, hospital personnel, and all other callers * Bilingual in English and Spanish * Experience with inbound and/or outbound customer service calls * Experience in a health insurance environment * Experience providing member care in a health insurance industry * Familiarity with the National Committee for Quality Assurance (NCQA) guidelines Please Note All positions subject to close without notice Intermountain Healthcare is an equal opportunity employer M/F/D/V Additional Details: Working Hours 40 Primary

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