Referrals Coordinator

Marathon Health is a leading provider of advanced primary care in the U.S., serving 2.5 million eligible patients through approximately 630 employer and union-sponsored clients. Our comprehensive services include advanced primary care, mental health, occupational health, musculoskeletal, and pharmacy services, delivered through our 680+ health centers across 41 states. We also offer virtual primary care and mental health services accessible in all 50 states. Transforming healthcare delivery with a patient-first approach, we prioritize convenient access to both in-person and virtual care, resulting in improved health outcomes and significant cost savings. Committed to inclusivity and collaboration, we foster a positive work environment and recruit exceptional talent to ensure expertise and compassion in healthcare delivery. Marathon has been recognized as a five-time Modern Healthcare Best Places to Work in Healthcare winner and a six-time Best in KLAS award winner for employer-sponsored healthcare services.

ABOUT THE JOB

The Referral Coordinator facilitates patient referrals for Marathon Health’s Value Driven Referrals service. Serve as a subject matter expert (SME) in using data and analytic tools to identify the highest quality, lowest cost specialists based on the patient geography, insurance and specific referral needs. Serve as the primary liaison between the patient and the referral specialist office, to ensure that the patient's preferences (urgency, quality, cost, location, availability, accommodations, etc.) are communicated and reflected in the care coordination.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Be the subject matter expert (SME) for all referral order types to ensure the patient receives the best opportunities for care. Knowledgeable of requirements and special considerations for visits with any specialist type order, requirements for all imaging order types, durable medical equipment, and more.
• Interview patients with orders from a Marathon Health provider to obtain patient preferences for care and to obtain any additional medical information necessary for care navigation. Advocate and assist patients in problem solving potential issues related to their care. 
• Aid patients, Marathon providers and clinic teammates with inquiries about the best options of care with respect to quality and financial considerations for the patient outside of Marathon Health.
• Facilitate the Value Driven Referral service as the assigned direct point of contact for the patient. This includes any actions to schedule appointments on behalf of the patient and communicate appointment details to the patient, specialist office, and Marathon clinic team.
• Act as a subject matter expert (SME) to understand the employer’s benefit package and insurance plan. Answer questions from the patient about their insurance plan and how coverage works to empower the patient to make the best choices for their care.
• Complete prior authorization requirements for care coverage. This includes providing medical information from the Athena chart like the patient history, diagnosis and the rule-out reason for referral. Provide any information to insurance companies to maximize reimbursement to the clinic and providers.
• Deliver exceptional customer service that is in alignment with a concierge service type.
• Be available to answer incoming calls on the shared Referral Team phone line and personal calls in a timely fashion.
• Responsible to document in multiple systems, such as Salesforce, Athena (EMR), OneNote, Availity (and other insurance sites) and Excel. 
• Request medical records post appointment to close the loop on patient care with the strictest confidentiality to maintain company integrity, patient and provider confidentiality, third-party administrator confidentiality and security of all data and records.

QUALIFICATIONS

High School Diploma and 2+ years of experience in a medical office, central scheduling or in a clinical navigator role or equivalent combination of education and experience.

DESIRED ATTRIBUTES

• Experience with insurance plans and companies, third-party payer practices and guidelines, and precertification and referral management for insurance plans required.
• Experience and ability to interview and obtain medical information from medical providers, medical assistants, and patients in a professional and courteous manner.
• Knowledge of and experience with medical terminology and procedural coding required; includes ability to interpret insurance information on PPO/EPO/POS/HMO/QPOS plans.
• Knowledge of Privacy Act and HIPAA Privacy Rule standards to maintain compliance, and to secure and protect medical and other protected health information.
• Experience successfully working remotely in a virtual setting preferred.
• Ability to work remotely in a secure confidential location; in a distraction-free without interruptions environment; with sufficient internet connections; and during the established schedule.
• Strong computer literacy with technical expertise using Microsoft Teams and Microsoft 365 including Word, Excel, Outlook, PowerPoint, etc. Experience working on dual monitors preferred.
• Excellent written and oral communications skills. Ability to communicate medical information with clients, patients, business leaders and professionals.
• Exceptional customer service skills and ability to promote teamwork. Ability to build and maintain trusting relationships by approaching all work with integrity and commitment.
• Meticulous attention to detail and excellent time management skills and ability to multi-task, prioritize work, execute a plan, and meet deadlines.
• Flexibility and adaptive skills with the ability to effectively manage competing priorities in a constantly evolving workplace in a fast-paced environment.
• High level of critical thinking, and creative and effective problem-solving skills.

Pay Range: $20.00-22.00/hr

The actual offer may vary dependent upon geographic location and the candidate’s years of experience and/or skill level.

We are accepting applications for this position until a candidate has been selected. To apply to this position and learn more about open jobs at Marathon Health, visit our careers page.

Marathon Benefits Summary

We believe in empowering teammates to do their best work and build better healthcare. Below are some of our benefit offerings. Eligibility is based on 24/hr week.

• Health and Well-Being: Free Marathon membership for in person and virtual care, employer paid life and disability insurance, and choice in medical/dental plans, vision, employer funded HSA, FSA, and voluntary illness, accident and hospitalization plans. Benefits are effective on the first of the month following date of hire.
• Financial Support: Competitive compensation, 401k match, access to financial coaching through our Employee Assistance Program
• Lifestyle: Paid time off for vacation, sick leave, and more, holiday schedule