Home Health Intake Referral Specialist

Presbyterian is hiring an Intake Referral Coordinator to serve as the Clearing House, Centralized Agency Representative for receiving all incoming calls/ clinical referrals from patients/members/providers and coordinating services from all community providers and designated PDS Hospitals and PMG clinics. Responsible for recognizing both expressed and implied customer needs and recommending the solution that will meet consumers desired outcomes. Gather all information needed to perform research and analysis for verifying member/patient eligibility/insurance/ongoing Authorizations and make decision regarding a referral to PHH, Hospice and Palliative Services as determined by payor sources/guidelines. Referring patients & providers to PHH clinical staff when assistance is needed with a more complex array of services or any inpatient levels of care. Assisting patients in finding appropriate providers for PHH services and availability within New Mexico and state border areas. Triages and manages complaints/problem calls from Patients.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

Per Required Need - Exempt: No
• Job is based at Remote Presbyterian El Camino
• Work hours: Varied Days and Hours
• Benefits: PRN/PT (working less than a .45 FTE) employee benefits available for this position such as medical, gym memberships and an employee wellness program.

• High School Diploma or GED required. Associate degree preferred.
• Five years experience working in a health facility required or 3+ years Insurance processing experience and direct patient contact required.

Education Essential: High School Diploma or GED

• Responsible for clearing the 18 Account/Billing/Claim Edit & registration Work Queue issues. Communicates to patient and family any benefit limitations, corrects and completes all insurance corrections to avoid write offs within timely filing guidelines. Demonstrates knowledge and understanding of managed care principles, payor, benefit information.
• Confirms signed orders from providers. Coordinate and submits authorization for services and documents appropriately into the computer system.
• Receives triages, and processes incoming referrals/calls from multiple sources including CDS & Regional HH Agency patients/providers and transcribes the necessary information. Gather clinical information from callers to determine clinical needs of member.
• Serves as the Clearing House, Centralized Agency Representative to facilitate the processing of the health referral to the receiving Community Agencies as determined by the patients Freedom of Choice and confirm placement for continuity of care.
• Coordinates and meets internal and external customer service expectations by recognizing both expressed and implied customer needs and recommending the solution that will meet the callers desired outcomes and achieve Patient Satisfaction Goals.
• Develops and maintains a working knowledge of all PHH service and resources available within the community, state and state border areas by developing & maintaining relationships with state wide agency personnel both in/outside the organization.
• Work with PHH clinical staff to refer members that require complex care coordination to the appropriately trained and assigned PHH clinical staff.
• Assumes responsibility for professional growth, development, and cross training activities for various program and shifts.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.