The Referral Coordinator acts as a subject matter specialist and provides Medicare Secondary Compliance guidance to teammates as well as Workers Compensation and Liability customers. Gathers necessary information and documentation to provide entitlement verifications, Medicare Set-Asides, and conditional payment investigations. Ensures that all cases are managed within company service standards and industry best practices. Manages audit/exception assignments and work condition reports through completion, communicates results, and makes recommendations to management.
Essential Duties and Functions
- Coordinates referrals for IMPAXX services on a national basis.
- Provides all parties with information and documentation needed to perform requested service in a timely manner, educates customers on services available and on Medicare Secondary Payer (MSP) compliance, assists in any way possible to ensure quality, timely service delivery and a high level of customer satisfaction, and acts as an advisor to our customers as a subject matter expert in MSP compliance.
- Enters data accurately into proprietary application of all referral intake information including customer, claimant demographics, type of services requested, special circumstances or requests.
- Types a variety of materials, including letters, memos, charts, inter-office communications, confidential reports, spreadsheets, and other correspondence as requested by the Process Manager, with responsibility for arrangement of attachments, formatting, and correct spelling, punctuation, and grammar.
- Manages files of documents and records as instructed by the Process Manager ensuring accurate and logical organization of files, and maintains confidential files as necessary.
- Receives, screens, and routes incoming telephone calls, provides information requiring knowledge of department policies and procedures, and resolves routine problems.
- Provides interpretations of memos from the Centers for Medicare & Medicaid Services (CMS) on a case-to-case basis for customers and determine how Medicare’s interests will need to be protected with a WC or liability settlement.
- Supports team cohesiveness through effective, respectful written and verbal communication while supporting the goals and vision of IMPAXX as a whole.
- Maintains an active caseload.
- Works vigorously to earn and keep customer trust.
- Provides customer service to clients by monitoring and resolving customer complaints that are escalated to management.
- Works across teams (Service, Recovery Services, and Submissions) to enhance service offerings to meet customer needs.
- Assesses processes and makes recommendations that streamline and further contribute to operational health with a continuous improvement mindset.
- Prepares assigned daily/weekly/monthly audit/exception reports.
- Manages assigned Work Condition Report.
- Performs other duties as assigned.
Qualifications and Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential functions.
- High School Diploma or equivalent
- Proficiency in Microsoft Office Suite
- Exceptional telephone demeanor
- Bachelor’s degree from an accredited university or college
- 1 to 3 years of Workers’ Compensation experience
- Experience managing an active case load