Referral Management Clerk (Kunsan AFB, South Korea)
EEC Solutions EEC Solutions Haines City, FL Haines City, FL Full-time Contract Full-time Contract From $65,000 a year From $65,000 a year 23 hours ago 23 hours ago 23 hours ago Referral Management Clerk This Position is to work at Kunsan Airforce base in South Korea Main Duties and
Responsibilities:
REFERRAL APPOINTING.
Review all new referral consults (those originating from patient visits, picked up from the clinics or printed at the RMC, for the TRICARE Managed Care Support Contractor (MCSC), emailed, in Referral Management System website, CHCS, AHLTA or faxed to the RMC) to ensure that each includes the following minimum information:
Patient's name FMP/Sponsor's social security number Patient's date of birth Home phone/work phone Originating clinic Specialty clinic being referred to Specific provider if so requested and contact for that provider Originating provider's name, phone number, and clinic Point of contact at the clinic if the provider is not available Provider's facsimile number Status of patient (Prime, Plus, Standard, Medicare) Number of visits authorized Time frame for consults Brief summary of reason for consult ICDB and CPT code(s), if required If the consult does not include the items listed in 5.
1.
4.
1.
1 the RMC staff shall fill in as much data as possible before returning the consult to the originating provider.
Determines health care that can be provided within the MTF or other DoD operated facility using Service Availability Listings (SAL) and information systems that link the referral to the patient's medical appointment.
Appoint patients on referrals they receive the same day the referrals are requested and within 30 minutes of arrival in the RMC.
Make every effort to book appointments within Access to Care (ATC) standards within the 8 MDG MTF, another MTF or to a host nation hospital at least 95 percent of the time.
ATC standards are:
emergency transport for STAT, within 72 hours for ASAP (as soon as possible), and within 28 days for Routine specialist appointments.
Advise the patient of the provider, location, time and day of the referral appointment prior to the patient leaving the facility.
For MTF referrals, direct the patient to call back on the next business day for appointment information if the patient is not provided appointment prior to leaving MTF.
If the patient does not call back within one business day, the RMC staff shall contact patient within three business days to book the appointment.
Book specialty appointments to Network providers and ensure that the referral result has been reviewed by the referring provider.
Provide monthly reports that show patients requiring referral care were treated with ATC standards.
Use information systems that link the referral to the appointment to the ATC category and standard.
HEALTH BENEFITS FUNCTIONS.
The RMC clerk shall:
Advise all categories of patients of what their referral/health treatment options are as related to their eligibility and beneficiary status (AD, Prime, Standard, civilian).
Advise on travel benefits and making travel arrangement with the Theater Patient Movement Requirements Center using the TRANSCOM Regulating and Command and Control Evacuation System if patient agrees to care at another Direct Care System MTF that is over 100 miles away and when military aircraft is used.
Advise and track on all patient categories (AD, Prime, Standard, and Civilian) that are admitted/referred as inpatients to local MOU hospitals.
REFERRAL TRACKING.
The RMC clerk shall:
Track all referral requests and results going out of and into the MTF in the Composite Healthcare Computer System (CHCS) system and on the 8 MDG Referrals Tracking Database.
Document patient's appointment, with whom, either in the MTF, another MTF, in the Network or with a non- network provider.
Document the name of the referring provider/PCM and MTF for purposes of returning specialty results to the referring provider/PCM.
Together with the RMC team members, track 100% of referral requests and results going out of and into the MTF in the Composite Healthcare Computer System (CHCS) system and on the 8 MDG Referrals Tracking Database.
Follow-up with MTF providers who did not complete referral results within 72 hours of the referral episode at 4 working days after the referral episode.
Ninety percent of the results shall be completed by 4 working days and 100% by 30 calendar days.
Ensure that results from other MTFs are returned to the referring provider in CHCS and/or AHLTA and to the medical record within 72 hours of the referral episode; notify the referring provider of the result via email, and by physically visiting and notifying the provider.
Ensure that results from Network/non-network providers are returned to requesting provider (internal or external) and to the medical record within 10 business days of the kept routine specialty encounter and within 24 hours for preliminary reports on urgent/emergent situations.
Follow-up with all Direct Care providers who did not complete referral results at 4 working days after the completion of the referral encounter, daily until the complete results are received, signed, acknowledged by the referring provider, and filed into the patient's medical record.
Follow-up with Network/Non-Network providers who did not complete referral results at 11 working days after the completion of the referral, daily until the complete results are received, signed, acknowledged by the referring provider, and filed into the patient's medical record.
Maintains and tracks referral records, referral results, follow-up referral results, and initiates the routing process to obtain provider's acknowledgement of results receipt.
Specifically, contractor will route the results for provider's signature, stamp and date.
The RMC Stamp provided by the 8 MDG will be utilized to initiate this process, and working in conjunction with the Patient Administration staff, oversees the processes to ensure that all referral results are filed into the patient's original medical record with 100% of results containing the referring provider's acknowledgement completed.
Provide monthly reports showing compliance percentage for MTF, other MTF, and Network/non- network providers' referral return rate.
Monthly reports shall include documentation of completing requirements outlined.
REFERRAL REVIEW.
The RMC clerk shall:
Review the referral for the following areas:
SuitabilityAdministrative and clinical completeness Covered TRICARE/CHAMPUS benefit for the specific patient via authorizations from MCSC Required tests and pre-work.
Submit referrals to non-network provider to MCSC via the fiscal responsible entity for medical necessity/appropriateness review.
Contact patient in event referral request is invalid, disapproved by second level review/MCSC and reschedule patient as soon as possible or instruct patient of other health care options.
COORDINATION FUNCTIONS.
The RMC clerk shall assist the TOPA Flight Commander:
Recommend where referral will be treated based on rule sets/MOUs/local market conditions, and on MTF capabilities.
Arrange travel orders, and non-medical attendants as required.
Ensure patient leaves MTF with all necessary documentation appropriate for the referred care episode and the referral provider knows where to return his/her results; goal is patient has tests and paper work before leaving MTF.
CUSTOMER SERVICE.
The RMC clerk shall:
Relieve requesting provider from as many administrative burdens as possible.
Provide the MTF referring provider with referral results.
Get the right patient to the right service/provider within Access to Care (ATC) standards.
Serve as the central clearing house for providers and patients needing help with referrals.
The RMC shall maintain and provide monthly statistical reports, due by the 15th of the following month.
The reportable information and data points may change, but the below entries represent an example:
Total consults received per specialty broken down into beneficiary category.
Total consults per provider and specialty.
Disposition of consults and reasons for deferral and denial.
Breakdown of time periods to access each specialty, internally and externally Total consults denied access to the MTF.
Rate of return for Direct Care System (72 hours) and Network/non-network providers (10 days) specialty reports.
Total recaptured care directed to the MTF.
Qualifications:
Education:
High School Diploma or General Educational Development (GED) equivalency, or completion of a ROK Ministry of Education accredited secondary education program.
Also acceptable is proof of completing any higher education program producing a degree or diploma.
Programs which only provide professional certifications do not meet this requirement.
Contract personnel shall be able to read, comprehend/understand, speak, and write English fluently.
English proficiency shall be verified through submittal of a TOEIC score above 750, or a college transcript showing completion of an English course, or completion of any higher education program in residence in the United States, or verifiable employment with the US Government for a period of no less than 1 year within the last 5 years.
Experience:
Contract personnel shall have at least 2 years of continuous employment with a single company, working in an administrative capacity (business, healthcare, clerical, etc.
).
Location:
Kunsan Air Force Base, South Korea For more information, visit us at www.
dbaeecsolutions.
com Job Types:
Full-time, Contract Pay:
From $65,000.
00 per year Application Question(s):
Has the ability to work in South Korea and live there for the duration of the contract.
Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
Responsibilities:
REFERRAL APPOINTING.
Review all new referral consults (those originating from patient visits, picked up from the clinics or printed at the RMC, for the TRICARE Managed Care Support Contractor (MCSC), emailed, in Referral Management System website, CHCS, AHLTA or faxed to the RMC) to ensure that each includes the following minimum information:
Patient's name FMP/Sponsor's social security number Patient's date of birth Home phone/work phone Originating clinic Specialty clinic being referred to Specific provider if so requested and contact for that provider Originating provider's name, phone number, and clinic Point of contact at the clinic if the provider is not available Provider's facsimile number Status of patient (Prime, Plus, Standard, Medicare) Number of visits authorized Time frame for consults Brief summary of reason for consult ICDB and CPT code(s), if required If the consult does not include the items listed in 5.
1.
4.
1.
1 the RMC staff shall fill in as much data as possible before returning the consult to the originating provider.
Determines health care that can be provided within the MTF or other DoD operated facility using Service Availability Listings (SAL) and information systems that link the referral to the patient's medical appointment.
Appoint patients on referrals they receive the same day the referrals are requested and within 30 minutes of arrival in the RMC.
Make every effort to book appointments within Access to Care (ATC) standards within the 8 MDG MTF, another MTF or to a host nation hospital at least 95 percent of the time.
ATC standards are:
emergency transport for STAT, within 72 hours for ASAP (as soon as possible), and within 28 days for Routine specialist appointments.
Advise the patient of the provider, location, time and day of the referral appointment prior to the patient leaving the facility.
For MTF referrals, direct the patient to call back on the next business day for appointment information if the patient is not provided appointment prior to leaving MTF.
If the patient does not call back within one business day, the RMC staff shall contact patient within three business days to book the appointment.
Book specialty appointments to Network providers and ensure that the referral result has been reviewed by the referring provider.
Provide monthly reports that show patients requiring referral care were treated with ATC standards.
Use information systems that link the referral to the appointment to the ATC category and standard.
HEALTH BENEFITS FUNCTIONS.
The RMC clerk shall:
Advise all categories of patients of what their referral/health treatment options are as related to their eligibility and beneficiary status (AD, Prime, Standard, civilian).
Advise on travel benefits and making travel arrangement with the Theater Patient Movement Requirements Center using the TRANSCOM Regulating and Command and Control Evacuation System if patient agrees to care at another Direct Care System MTF that is over 100 miles away and when military aircraft is used.
Advise and track on all patient categories (AD, Prime, Standard, and Civilian) that are admitted/referred as inpatients to local MOU hospitals.
REFERRAL TRACKING.
The RMC clerk shall:
Track all referral requests and results going out of and into the MTF in the Composite Healthcare Computer System (CHCS) system and on the 8 MDG Referrals Tracking Database.
Document patient's appointment, with whom, either in the MTF, another MTF, in the Network or with a non- network provider.
Document the name of the referring provider/PCM and MTF for purposes of returning specialty results to the referring provider/PCM.
Together with the RMC team members, track 100% of referral requests and results going out of and into the MTF in the Composite Healthcare Computer System (CHCS) system and on the 8 MDG Referrals Tracking Database.
Follow-up with MTF providers who did not complete referral results within 72 hours of the referral episode at 4 working days after the referral episode.
Ninety percent of the results shall be completed by 4 working days and 100% by 30 calendar days.
Ensure that results from other MTFs are returned to the referring provider in CHCS and/or AHLTA and to the medical record within 72 hours of the referral episode; notify the referring provider of the result via email, and by physically visiting and notifying the provider.
Ensure that results from Network/non-network providers are returned to requesting provider (internal or external) and to the medical record within 10 business days of the kept routine specialty encounter and within 24 hours for preliminary reports on urgent/emergent situations.
Follow-up with all Direct Care providers who did not complete referral results at 4 working days after the completion of the referral encounter, daily until the complete results are received, signed, acknowledged by the referring provider, and filed into the patient's medical record.
Follow-up with Network/Non-Network providers who did not complete referral results at 11 working days after the completion of the referral, daily until the complete results are received, signed, acknowledged by the referring provider, and filed into the patient's medical record.
Maintains and tracks referral records, referral results, follow-up referral results, and initiates the routing process to obtain provider's acknowledgement of results receipt.
Specifically, contractor will route the results for provider's signature, stamp and date.
The RMC Stamp provided by the 8 MDG will be utilized to initiate this process, and working in conjunction with the Patient Administration staff, oversees the processes to ensure that all referral results are filed into the patient's original medical record with 100% of results containing the referring provider's acknowledgement completed.
Provide monthly reports showing compliance percentage for MTF, other MTF, and Network/non- network providers' referral return rate.
Monthly reports shall include documentation of completing requirements outlined.
REFERRAL REVIEW.
The RMC clerk shall:
Review the referral for the following areas:
SuitabilityAdministrative and clinical completeness Covered TRICARE/CHAMPUS benefit for the specific patient via authorizations from MCSC Required tests and pre-work.
Submit referrals to non-network provider to MCSC via the fiscal responsible entity for medical necessity/appropriateness review.
Contact patient in event referral request is invalid, disapproved by second level review/MCSC and reschedule patient as soon as possible or instruct patient of other health care options.
COORDINATION FUNCTIONS.
The RMC clerk shall assist the TOPA Flight Commander:
Recommend where referral will be treated based on rule sets/MOUs/local market conditions, and on MTF capabilities.
Arrange travel orders, and non-medical attendants as required.
Ensure patient leaves MTF with all necessary documentation appropriate for the referred care episode and the referral provider knows where to return his/her results; goal is patient has tests and paper work before leaving MTF.
CUSTOMER SERVICE.
The RMC clerk shall:
Relieve requesting provider from as many administrative burdens as possible.
Provide the MTF referring provider with referral results.
Get the right patient to the right service/provider within Access to Care (ATC) standards.
Serve as the central clearing house for providers and patients needing help with referrals.
The RMC shall maintain and provide monthly statistical reports, due by the 15th of the following month.
The reportable information and data points may change, but the below entries represent an example:
Total consults received per specialty broken down into beneficiary category.
Total consults per provider and specialty.
Disposition of consults and reasons for deferral and denial.
Breakdown of time periods to access each specialty, internally and externally Total consults denied access to the MTF.
Rate of return for Direct Care System (72 hours) and Network/non-network providers (10 days) specialty reports.
Total recaptured care directed to the MTF.
Qualifications:
Education:
High School Diploma or General Educational Development (GED) equivalency, or completion of a ROK Ministry of Education accredited secondary education program.
Also acceptable is proof of completing any higher education program producing a degree or diploma.
Programs which only provide professional certifications do not meet this requirement.
Contract personnel shall be able to read, comprehend/understand, speak, and write English fluently.
English proficiency shall be verified through submittal of a TOEIC score above 750, or a college transcript showing completion of an English course, or completion of any higher education program in residence in the United States, or verifiable employment with the US Government for a period of no less than 1 year within the last 5 years.
Experience:
Contract personnel shall have at least 2 years of continuous employment with a single company, working in an administrative capacity (business, healthcare, clerical, etc.
).
Location:
Kunsan Air Force Base, South Korea For more information, visit us at www.
dbaeecsolutions.
com Job Types:
Full-time, Contract Pay:
From $65,000.
00 per year Application Question(s):
Has the ability to work in South Korea and live there for the duration of the contract.
Work Location:
In person.
Estimated Salary: $20 to $28 per hour based on qualifications.
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