Referral Coordinator

Job Summary:

As a Medefy Referral Coordinator you will be coordinating between Medefy app users, Medefy team members, and healthcare providers and pharmacies to facilitate users’ access to low-cost, high-quality healthcare in a friendly and time‐sensitive manner. Your overall goal is to use your communication skills and knowledge to cut through the confusion, difficulty, high costs, and waste in healthcare so that users complete a successful and pleasant healthcare journey.

Although many insurance plans do not require referrals, Medefy Referral Coordinators coordinate the entire referral process to streamline and simplify the scheduling process for Medefy members. This may include, but is not limited to, explaining benefit details, identifying a provider and verifying network status, obtaining notes or records from a provider, obtaining orders from a referring provider, prompting a provider to schedule an appointment, coordinating medications, sending updated insurance information to a provider, following through with members and providers to ensure completion of all steps in the process, and identifying any after-action needed as a result of appointments.

About our awesome company, Medefy Health...

Medefy Health (www.Medefy.com) is a healthcare benefits navigation SaaS company headquartered in Tulsa, OK. We’re proud to be Oklahoma’s #1 fastest-growing company and rated by Inc. Magazine as the 37th fastest-growing tech company and the 288th fastest-growing company overall in the USA…and our story is still being written!

Healthcare is only getting more complicated, and more expensive, for employers and their employees. This is where Medefy Health comes in. We’re on a mission to eliminate the stress on hard-working families caused by an impossible to navigate healthcare system. All while saving them, and their employers, a significant amount of time and money. We demolish barriers between healthcare and the people who need it, and we need your help to further our mission!

Job Duties & Responsibilities:

• A professional phone demeanor while communicating with medical facilities, provider offices and pharmacies while assisting end users who may be experiencing challenges
• Help shepherd Medefy app user needs from Medefy Care Guides to identify low-cost, high-quality doctors and facilities to assist users successfully complete their healthcare journey
• Act as a direct point of contact for members and providers, assisting them with medical and pharmacy benefit information, prior authorization requests, and navigation support. You'll handle referrals through various channels, such as phone, fax, email, and written correspondence, ensuring that individuals’ pharmacy and/or medical requests are resolved
• Understand the referral funnel process, ensuring that users first access low-cost options before others
• Advocate for the user at all levels throughout the healthcare journey to ensure their will is carried out
• Utilize strong organizational and time management skills to systematize a care plan for several patients at once, while coordinating with diverse healthcare workers who hold varied schedules
• Use highly developed verbal and written communication skills to expedite and facilitate understanding of patient’s health needs while maintaining a high level of respect and confidentiality for the patient
• Coordinate via phone with multiple doctors’ offices, facilities, pharmacies and third-party administrator/carrier resources to ensure successful user outcome
• Quickly and effectively request/transfer patient records, orders, and other information between healthcare entities in a HIPAA-compliant manner
• Familiarize yourself with the details of Medefy client company health plans, third party vendors, health insurance, benefits details, and other relevant items necessary to facilitate user solutions
• Familiarize yourself with Medefy software platform tools, HIPAA, and office policies
• Work hand‐in‐hand with other Medefy departments to help users successfully complete their healthcare journey
• Stay up to speed with Medefy client health plan changes, amendments, and alterations
• Other duties as assigned

You must have at least the following:

• 1-2 years of experience working as a pharmacy technician or 1-2 years in a mail order and/or specialty pharmacy or with medical or pharmacy claims processing
• 1+ year of medical insurance verification and pre-certification
• High school diploma/GED and some post-secondary education/training
• Familiarity with online insurance verification of deductibles and co-insurance calculations
• Experience working directly with carriers, providers and patients
• Experience utilizing your innate abilities as a detail-oriented, adaptable, critical thinker, and proactive problem solver to consistently achieve patients' healthcare objectives while delivering exceptional customer service
• Proven ability to build rapport and work effectively with a variety of individuals
• A good knowledge of the general healthcare ecosystem and trends, including terminology
• A relentlessly inquisitive nature, love researching and finding new answers
• A professional phone demeanor, especially when assisting others who are experiencing challenges
• The ability to multitask and work quickly and efficiently
• Ability to prioritize workflow according to the business need
• Proficiency with computers, Microsoft Office, apps, and instant messaging

It would be great if you have:

• Bachelor’s degree
• An active Certified Pharmacy Technician (CPhT) certification
• In-depth understanding of healthcare referral management practices, with the ability to effectively communicate these practices to members and providers
• Back-office medical experience
• Experience working in a data-driven environment and a proven track record of achieving performance targets

Supervisory Duties: No supervisory duties

Travel Requirements Percentage: None- 0%

Physical and Mental Requirements:

• Occasionally move inside the office to access file cabinets, office machines, etc.  
• Prolonged periods of being stationary at a desk and working on a computer 
• Communicating with others to exchange information via typing
• Must have close-range clarity of vision with or without corrective lens 
• Ability to simultaneously address multiple complex problems; Multitask without loss of efficiency or accuracy, able to perform duties from multiple sources 
• Interact appropriately with a variety of individuals including customers, clients, and vendors and under adverse circumstances 
• Must maintain regular attendance and be punctual 
• Must be able to exercise independent judgment and make sound decisions

What do we have that you want?

We get to change lives…every day! We have an amazing team dedicated to helping people get the healthcare they need out of a system that regularly takes advantage of them – at a price they can afford. Seriously, dedicated is an understatement. We work in a fun, easygoing (but still fast-paced) environment and get to work together in one of the most powerful healthcare software platforms in the world. We all have a burning desire to use that platform to help others with their healthcare challenges and we keep an open mind for new methodologies to accomplish our mission. We want you to want to be here, so we also offer competitive pay and benefits packages as well as an amazing culture!

**Job description is not a comprehensive listing of all the activities, duties or responsibilities that are required of the employee. Duties, responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.