Referral Operations Manager

Referral Operations Manager

Under the direction of the Vice President of Operations, the Referral Operations Manager will be responsible for overseeing referral processes and ensuring accurate insurance verification and eligibility for patients ahead of their visit. The Manager will ensure referrals are processed, tracked, and completed in a timely manner, while collaborating with leadership to address challenges in care coordination and insurance verification. This role includes building new referral networks, optimizing workflows, and maintaining strong relationships with referral partners. Additionally, you will track key performance indicators (KPIs), lead special projects, and ensure compliance with accreditation standards. The Manager will also provide coaching, support team development, and step in to assist with daily tasks when needed.

North Shore Community Health (NSCH) is a highly accomplished community health organization that prides itself on its compassionate approach to serving the surrounding communities with comprehensive and culturally sensitive care. With a strong commitment to excellence, NSCH provides:

• Comprehensive primary care.
• Dental services.
• Behavioral health care.
• Care management.
• Pharmacy services.
• Substance abuse disorder treatment.
• Nurse care management.
• Insurance enrollment assistance.

NSCH operates service sites at Gloucester, Peabody, and Salem Family Health Centers, ensuring convenient access to care. Additionally, NSCH extends its reach through school-based health centers within the Salem and Peabody School Districts. NSCH collaborates with Bentley Academy, Collins Middle School, Horace Mann School, Bates Elementary School, and the Peabody Learning Academy for behavioral health services.

As a community-based safety net healthcare provider, NSCH actively encourages diversity and welcomes staff members who reflect the rich tapestry of our communities. We highly value the contributions of our team members and offer a wide range of perks and comprehensive benefits. These include health and wellness benefits, tuition reimbursement, loan forgiveness opportunities, and other appealing benefits.

We believe in supporting our employees from day one, and all eligible staff members can take advantage of these benefits right from the start of their employment at NSCH. We aim to foster a supportive and rewarding environment that empowers our team members to provide exceptional care to our communities.

North Shore Community Health's mission is to build healthy communities by providing exceptional care to all.

Healthy People | Vibrant Communities

Accountability: We take our responsibility to ourselves, each other, and the NSCH Community very seriously. We understand our individual roles and positions of power with respect to how others perceive our roles and actions. We hold ourselves accountable when we make mistakesacknowledging the error, owning it, taking corrective actions, and moving forward. We follow through on what we commit or resolve to do.

Integrity: Integrity is the foundation of healthy relationships. We are committed to the highest ethical standards: honesty, fairness, respectfulness, and trustworthiness. We are honorable and respectful in dealings with others, and we strive to deal honestly, fairly, and in a respectful, ethical, and trustworthy manner when in agreement or disagreement.

Empathy: Empathy is a deep appreciation for another's situation and point of view, which is the basis for the golden rule and our intrinsic sense of justice. We strive to bring empathy into our interactions with each other and with our patients.

Courage: We see courage as the strength of character to stand up for our convictions and belief system. To have courage is to have the fortitude to take risks and to extend one's behaviors, actions, and thoughts beyond one's comfort zone. We appreciate that courage is often required to compromise. Courage is a state of mind to face adverse, difficult, and challenging situations with confidence and positive energy.

Respect: NSCH holds its patients in the highest regard. We provide care that is respectful of and responsive to individual patient needs and values. We take the time to listen to concerns, understand what is important, and provide appropriate solutions and care. We do this through coordination and integration of care, collaboration, and teamwork.

Commitment: NSCH is committed to the health and well-being of its community, patients, and staff. We demonstrate this commitment by constantly striving to align our actions with our mission, vision, and values.

EEO Statement: We, North Shore Community Health (NSCH), are an equal employment opportunity employer. Our goal is to have a diverse workforce representative of all people, at all job levels, in the organization. We do not and will not make any personnel decisions (like recruiting, hiring, job assignments, and promotions) based on age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity, gender expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state, or local law.

Requirements

Essential Duties and Responsibilities

• Manages the work of the Referral Coordinators including ensuring that appointments are verified appropriately, referrals are appropriately processed and tracked, and new patients assigned via Community Care Cooperative (C3) are scheduled in a timely manner.
• Tracks data relating to common outgoing referrals and works to optimize processes around care coordination, patient education, scheduling, tracking, and loop closure
• In partnership with Operational Leadership, works to identify common issues related to insurance verification and eligibility and develop strategies to mitigate these issues to improve referrals
• In partnership with clinical leadership, identifies gaps in referral networks and connects to new partners in the North Shore region and beyond to establish new referral pathways
• Maintains relationships with referral partners, providing feedback when necessary to ensure timely, high-quality care for North Shore patients.
• With support from the Vice President of Operations, leads implementation for special projects (short or long-term), initiatives, and tasks as assigned.
• Communicates to staff regarding changes to verification- and referral-related workflows and participates in ongoing clinical training as it relates to referral ordering.
• Identifies and monitors key performance indicators (KPIs) that relate to the success of the referrals department.
• Ensures Referral Team staffing levels and skill levels are maintained throughout operational hours
• Provide coaching to Referral Coordinators to ensure technical knowledge and expertise are maintained and developed.
• Support the Referral Coordinators to ensure they have the right tools to provide optimal performance and that all processes and protocols are followed appropriately
• Monitor staff performance, provide day-to-day supervision of staff, including training, coaching, time and attendance, etc., and provide support in escalated calls and priorities
• Oversee referral tracking procedures to ensure that all referrals that are tracked are managed within an appropriate time
• Carry out functions associated with Referral Coordinator role as needed
• Monitor, sort, and address incoming faxes to NSCH's referral fax line as well as letter mail received at our administrative site
• Leads onboarding of new Referral Coordinators
• Own competencies named by accreditation bodies (e.g. NCQA) related to referrals and maintain compliance
• Ensure that the Electronic Health Record has the most up-to-date information regarding specialists in our area of care
• Maintain appropriate documentation on the referrals to promote team awareness and efficiency with the referral tracking
• Communicate professionally with all individuals associated with the referral process, both internally and externally

Required Skills and Abilities

• Strong organizational and communication skills.
• Ability to work effectively in a culturally diverse environment.
• Team-oriented with a collaborative approach.
• Detail-oriented with strong problem-solving skills.
• Respectful and able to maintain patient confidentiality

Education & Experience

• High School Diploma required.
• Minimum of three (3) years of experience in a healthcare setting.
• Minimum of five (5) years of customer service experience, preferably in a healthcare setting.
• Demonstrated leadership experience with the ability to multitask effectively.
• Prior supervisory experience preferred.
• Experience with Medicare, Medicaid, and managed healthcare.
• English/Spanish bilingual ability preferred.

Work Environment Conditions

• Clinic, urgent care, mobile unit, telehealth, etc.
• Potential exposure to infectious diseases
• This position operates in a professional, fast-paced, and collaborative environment.
• Regular interaction with colleagues, supervisors, and/or clients occurs in person, by phone, and via digital communication platforms.
• Standard office hours apply, with occasional flexibility required to meet deadlines, attend meetings, or respond to organizational needs.
• Work may require sitting or standing for