Description

PUYALLUP TRIBAL HEALTH AUTHORITY, located in Tacoma, Washington is seeking an experienced Referral Services Supervisor. The Referral Services Supervisor will manage the daily operations of the Referral Services and Patient Benefit Departments to ensure compliance with applicable regulations. They will analyze, evaluate, and report utilization of referred services and partner with the Member Services Department to ensure the highest quality patient care to Tribal Members. 

ESSENTIAL FUNCTIONS:

• Responsible for monitoring referral patterns and making recommendation on strategies to contain costs, improve access, and ensure quality of care.
• Supervise day-to-day activities and work assignments of the Referral Services Patient Benefit staff, provide on-going training and performance evaluations annually or as needed.
• Understand and ensures compliance with applicable federal regulations, contractual obligations and organizational policies pertaining to the authorization of referred services.
• Prepare statistical and narrative reports for departmental Director or Administrative staff on utilization patterns, expenditures by revenue stream, demographics of service delivery and trending patterns as requested.
• Establish and maintain a reporting system for monitoring the use of outside providers and tracking and estimating the expected costs of referrals.
• Partner with Member Services to continually improve services to Tribal Members (i.e., coordinating external services and resolving referral, coverage and claims payment issues).
• Recommend and advise on organizational policies, initiatives, processes and procedures to ensure quality patient care.
• Create, develop and implement departmental policies, processes and procedures to ensure quality patient care.
• Ensure the implementation of applicable practice guidelines and referral criteria established by the Clinical Director.
• Serve as liaison by establishing and maintaining positive relationships between PTHA internal providers and outside providers who provide services to PTHA patients and assist in negotiating access to care in targeted areas.
• Develop annual operating budget and manages department expenditures to meet approved budget.
• Participate as a member of the Clinical Review Committee for the resolution of complex cases, appeals, operational changes, and insurance issues.
• Remain knowledgeable in ICD Diagnostic coding, CPT procedural coding, and length of stay guidelines.

Requirements

• Bachelor’s degree with three (3) years’ experience in referrals management in a healthcare setting. 
• Intermediate proficiency with MS Outlook and MS Office Suite (Word, Excel, PowerPoint and Access) or similar applications.
• Experience and/or ability to work with an Electronic Health Records System.
• Any equivalent combination of education and healthcare referral experience may be substituted.