Referral Coordinator, Health Plan Management Unit (Los Fresnos, TX)
Strategic Resources, Inc. (SRI) is an international, ISO 9001:2015 Certified, CMMI Level 3 Rated full-service provider with more than 33 years’ experience in the Federal, military, and commercial marketplaces. SRI is seeking full-time committed and passionate Referral Coordinators to join our team to provide critical services to detainees in custody at the U.S. Immigration and Customs Enforcement (ICE) Health Services Corps (IHSC) Medical Facilities in support of the U.S. Immigration and Customs Enforcement (ICE) Health Services Corps (IHSC) Detention Center Healthcare contract opportunity.
SRI offers our full-time employees a competitive benefits package to include health, dental, vision, 401K, life insurance, short-term and long-term disability plans, vacation time and holidays. Please visit the SRI career page at https://www.sri-hq.com/careers/learn-more.
The ICE IHSC exists within the organizational structure of the United States Enforcement and Removal Operations (ERO) under the supervision of the Department of Homeland Security (DHS). The United States Public Health Service (USPHS) Commissioned Corps Officers, civil service staff and contractors comprise the healthcare professionals working together to provide quality healthcare services. IHSC serves as the medical experts for ICE detainee health care. IHSC is committed to excellence in detention and correctional health care and the provision of safe and high-quality care to those in ICE custody.
Description of Duties:
The Referral Coordinator (RC) administratively processes IHSC medical referrals for off-site medical appointments. In addition, they schedule off-site specialty consults and follow-up appointments and request and upload medical records to the electronic Health Record (eHR). The RC is the primary point of contact (POC) and liaison between the IHSC Health Plan Management Unit (HPMU), requesting provider, and the community provider to initiate enrollment as well as assist with billing and claims resolution as applicable. The RC maintains a system of records for reference in support of the IHSC HPMU Provider Network.
Duties and Responsibilities:
- Prepares, updates, and maintains medical referral information for each patient ensuring accuracy of information in the patient’s medical record.
- Supports the IHSC outside provider recruitment process as liaison between providers and IHSC. Maintains a system of records for tracking purposes for reference in support of the IHSC HPMU Provider Network.
- Coordinates the purchase or rental of durable medical equipment for detainees in ICE custody.
- Contacts the off-site community medical providers to schedule appointments for specialty care based on IHSC provider referral and documents specific appointment date in the eHR.
- Tracks compliance with scheduled patient appointments, making timely reminder notices, or calls to the off-site facility (hospitals, long-term care facilities, etc.) and IHSC staff prior to each appointment where applicable.
- Coordinates transportation with custody transport staff for the scheduled off-site medical appointments and creates the sealed medical packet that is sent with the patient, via custody transportation staff, that contains pertinent medical documentation for the appointment.
- Files/scans laboratory, radiology, and other reports in appropriate sections of the electronic medical record when patient returns from off-site visit.
- Routes clinical reports to appropriate clinic staff within prescribed timeline.
- Corresponds with off-site medical facilities and HPMU Provider network providers to request pertinent medical information to place in the medical record using appropriate and authorized ICE and IHSC forms. Tracks requests and performs follow-up ensuring receipt of information requested.
- Handles all correspondence requiring authorizations for payment of medical services.
- Reviews all documentation for completeness and routes incomplete documents to the appropriate provider for correction prior to placing/scanning in the medical records.
- Receives and processes requests for information in accordance with the Fair Information Practice Principles and Privacy Act.
- Uses multiple systems to process a variety of narrative and tabular material (e.g., eHR systems, email correspondence, Excel tabular data, Enterprise Business Optimizer reports, etc.) to prepare, update, and maintain a medical record and provide required and requested information to appropriate medical personnel.
- Completes reports needed to ensure that all referrals have been completed correctly before they are transmitted to the VA system for payment and corrects any errors found.
- Assists to reconcile and resolve denied outside provider claims.
- Performs record keeping functions in accordance with program policies and position.
- Maintains functional proficiency and ease of use utilizing electronic health records and referrals.
- Completes and passes all Referrals Coordinator competencies, initially and annually.
- Completes all initial, annual, and ad hoc training as required/assigned.
- Serves as a team member for analyzing established protocol practices and identifying areas for improvement.
- Maintains patient confidentiality, and confidentiality of medical records, in compliance with the Privacy Act and HIPAA regulations in all work activities.
- Adheres to and maintains awareness of: IHSC Policies, Procedures, Directives, Operational Memoranda, and accreditation standards as prescribed by ICE/IHSC.
- Adheres to and participates in: IHSC’s Safety, Quality Improvement and other programs and collateral duties as appropriate to position.
- Attends and participates in general/medical staff meetings.
Required Education and Experience:
- High School Diploma or GED equivalent.
- Minimum of one-year experience in a healthcare setting as a medical record technician, medical record clerk, or similar position where the processing of electronic medical/health records and was part of the daily responsibilities.
- Minimum of one-year experience with the scheduling of medical appointments, such as radiology procedures, specialty consults follow-up appointments, and surgical procedures.
Required Licensure and Certifications:
- This position does not require privileging by IHSC.
- Maintains Heartsaver® CPR AED certification through the American Heart Association®. Must include hands on training and practice with an instructor and a mannequin.
Required Knowledge, Skills, and Abilities:
- Knowledge of the basic principles and standards of eHR procedures and methods.
- Knowledge of the documentation requirements, timeliness of referral management, and knowledge of eHR workflow to process electronic medical referrals and records, to review referrals and records for accuracy and completeness, and to keep track of processing deadlines.
- Basic fluency of medical terminology.
- Administratively processes IHSC medical referrals for off-site medical appointments.
- Schedules off-site specialty consults and follow-up appointments. Requests and uploads medical records to the electronic Health Record (eHR).
- Recognize documentation inconsistencies in referrals within the eHR ensuring compliance and resolution.
- Knowledge of Current Procedural Terminology (CPT) codes
- Ability to work in a multi-cultural environment.
- Ability to work approximately 90% of time using a computer, telephone, scanner, and printers.
- Ability to utilize telephonic interpreter/translation services to complete assigned duties if not fluent in a language the patient understands.
- Ability to adapt to sudden changes in schedules and flexibility in work requirements.
- Ability to communicate proficiently in English (verbal and written) to develop positive rapport with patients, co-workers, and other stakeholders.
- Ability to establish and maintain positive working relationships in a multidisciplinary environment.
- Ability to navigate in an electronic work environment including eHR, ICE web-based trainings and Microsoft Teams application navigation.
- Knowledge of and functional proficiency in common Microsoft Office programs, specifically Microsoft Word, Excel, Outlook, and SharePoint.
- Knowledge of regulations (HIPAA/Privacy Act) regarding the confidentiality of patient medical records and information as well as Personally Identifiable Information (PII).
Attributes and Professional Qualities:
- Strong oral and written communication skills.
- Excellent interpersonal skills.
- Critical thinking skills.
- Cultural competency.
- Integrity and honesty.
- Verbal and written proficiency in Spanish (preferred, not required)
- Experience in a detention/correctional or residential healthcare setting (preferred, not required).
Duty Hours/On-Call Requirements:
- IHSC operates 24/7/365; this position is required to respond during an emergency activation.
- This full-time position requires availability to work available days, evenings, as well as weekends and holidays. Night shifts may be requested at times based on mission needs but are generally not required. (Site specific).
- On-call availability is not required for this position.
- The work requires some physical exertion, such as long periods of standing; walking or jogging unaided over rough, uneven, or rocky surfaces; recurring bending, crouching, stooping, stretching, reaching, or similar activities; or recurring lifting of moderately heavy patients or equipment.
- The work may require specific, but common, physical characteristics and abilities, such as agility and dexterity, visual, and hearing capabilities.
- Must be able to respond to any medical emergency in the facility, via foot, within four minutes and perform CPR/emergency care standing or kneeling.
- Must have the ability to assist sick, injured, or aging detainees or staff exiting the building during an emergency
- The Department of Homeland Security’s Personnel Security Unit (PSU) must render a Preliminary Favorable Fitness Determination to be considered a qualified candidate.
- A Complete Favorable Fitness Determination must be rendered by PSU upon completion of initial and subsequent background investigations to meet the requirements of this position.
- Must be a U.S. Citizen or Legal Permanent Resident.
SRI is an Equal Opportunity Employer and Affirmative Action Employer