Referral & Student Health Insurance Coordinator

JOB SUMMARY

Plans, coordinates and/or performs administrative, business management or support services activities.

10% - Communication and Marketing Support:
Collaborates with internal stakeholders to review, update, and coordinate the development and ordering of printed materials, including appointment cards, MyHealth-e cards, orientation materials, and Bridge to Clemson publications. Ensures accuracy, consistency, and alignment of communication with organizational messaging and operational needs. Serves as the Student Health Services coordinator for new student orientation activities and the Bridge to Clemson program by managing the planning, communication, and implementation of related processes.

Maintains current and accurate after-hours care information on the Student Health Services website and ensures accessibility by coordinating the placement and upkeep of QR code decals on clinic doors that direct patients to this information. Supports the Clinical Practice Manager in the development, review, and update of print and digital communications, including website content, to ensure timely and effective 35% - Student Health Insurance Plan (SHIP) Coordinator:
Coordinates and tracks SHIP enrollment and waiver processes to ensure compliance with University Policies and requirements. Coordinates file transfers to assure the proper identification of new enrollees and those that have submitted waivers. Reconciles invoices from the insurance carrier with the University documentation of students charged for insurance. Submits administrative enrollments as needed. Collaborates with the Dean of the Graduate School, Office of International Services, and Student Financial Services to ensure effective communication and accurate implementation of SHIP processes.

Communicates SHIP highlights, changes, enrollment, and waiver procedures through various channels to inform new and continuing students. Meets with students/parents to explain SHIP benefits and costs. Represents Student Health Services at International and Graduate student orientations and assists with the revision and distribution of orientation information. Assists students with enrollment and waiver procedures and provides guidance throughout the process. Assists students in resolving claims issues with SHIP insurance carrier and outside providers.

Coordinates and facilitates prior authorization requests for SHIP members, working with the insurance carrier, healthcare providers, and students to ensure required documentation is submitted and authorization requirements are met. Attends weekly meetings with Academic Health Plan representatives to provide updates, discuss program activities, and resolve outstanding issues. Responsible for credentialing 55% - Referral Coordinator:
Coordinates and manages medical and mental health clinic referral appointments in accordance with Redfern Health Center (RHC) policies and procedures, including scheduling, tracking, and follow-up. Collaborates with healthcare providers to determine the most appropriate specialists or facilities based on patient needs and insurance coverage. Maintains accurate and comprehensive referral documentation within the electronic health record (EHR) and monitors referral progress to ensure completion of appointments and timely receipt of consultation reports.

Proactively follows up with external providers to obtain outstanding documentation and ensures all reports are uploaded and routed to the referring provider for review. Communicates regularly with patients regarding referral status and assists with appointment coordination as needed. Provides support to patients in verifying insurance benefits and clarifying potential out-of-pocket costs. Maintains and updates referral resources, including provider lists, within the EHR to ensure accuracy and usability.

Prepares detailed monthly reports on referral activity, including referral volume and outcomes, and provides regular updates to providers and leadership on trends and identified issues. Maintains and updates the Outside Referrals Policy and Procedures and ensures the Referral Office Update spreadsheet remains current and accurate.

AH10

Regular FTE Staff

A high school diploma and relevant experience in business management, public administration, or administrative services or a bachelor's degree may be substituted for the required work experience.

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