POSITION CLOSES: March 26, 2023

PUYALLUP TRIBAL HEALTH AUTHORITY, located in Tacoma Washington is seeking a full time Referral Services Supervisor.

GENERAL FUNCTION: Manage the daily operations of the Referral Services and Patient Benefit Departments to ensure compliance with applicable regulations. Analyze, evaluate, and report utilization of referred services. Partner with 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.

 Bachelor’s degree with three (3) years’ experience in referrals management in a healthcare setting and three (3) years’ direct supervisory experience of three or more employees. Minimum 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.