Job Specifications:

Reports directly to the Medical Referral Office Lead, responsible for providing warm and pleasant customer service in assisting members regarding issues and concerns such as but not limited to off-island authorization, eligibility, benefit administration, claims, billing, reimbursements, medical records, etc. and administrative support to functions related to the Medical Referral Office processes.

Duties and Responsibilities:

I. Medical Referral Office Services

1.         Greets and assists walk-in members.

2.        Handles and documents check-in of walk-in members on log-sheet.

3.         Helps/assists walk-in members connect with the right department and/or individuals

4.        Answers incoming calls and directs them accordingly.

5.        Forwards inquiries and concerns to appropriate staff/departments (e.g. other Medical Referral Office staff, Medical Management, Claims, Customer Service, MAS, Sales, etc.) or providers (e.g. doctor’s clinics, hospital departments, etc.)

6.        Secures appointments for members related to their off-island referral.

7.         Escorts members to providers’ clinics for their consultations and to departments within the provider facilities for various medical services and procedures.

8.        Provides offsite letters of authorization to members for services not requiring prior authorization.

9.        Provides assistance and support to members throughout the admission and discharge process for inpatients.

10.    Computes and explains member’s financial responsibility by reviewing statements of account.

11.     Provides customer support throughout the care coordination including but not limited to any of the following concerns:

11.1. Authorization (including Off-Island),

11.2.Eligibility,

11.3. Benefit Administration,

11.4.Referrals,

11.5. Appointments,

11.6.Claims,

11.7. Billing,

11.8.Reimbursements,

11.9.Plan Deductible,

11.10.       Referrals (status & process),

11.11.        Insurance Coverage,

11.12.       Coordination of Benefits

11.13.        Services available,

11.14.       Network Providers/Access,

11.15.        Medical Records

11.16.       Appeals

11.17.        Grievances

12.    Provides assistance to member for concerns related to off-island travel, transportation, accommodation, etc.

13.     Provides benefit information to members to facilitate understanding of benefit coverage, plan limitations and exclusions.

II. Administrative Support

1.         Collects updated membership information from walk-in members.

2.        Updates and maintain member walk-in, phone, and email inquiry demographics on a weekly basis.

3.         Updates and organizes member files.

4.        Regularly inputs member-related information into the company’s digital database.

5.        Provides administrative support related to Medical Referral Office functions.

6.        Performs other duties that may be assign from time to time.