Overview:
As the largest and leading value-based kidney care company, Somatus is empowering patients across the country living with chronic kidney disease to experience more days out of the hospital and healthier at home.
It takes a village of passionate and tenacious innovators to revolutionize an industry and support individuals living with a chronic disease to fulfill our purpose of creating More Lives, Better Lived. Does this sound like you?

SHOWING UP FOR YOU

We offer more than 25 Health, Growth, and Wealth Work Perks to help teammates learn, grow, and be the best version of themselves, including:

• Subsidized, personal healthcare coverage (medical, dental vision)
• Accrual of 3 weeks’ Vacation (PTO)
• Professional Development, CEU, and Tuition Reimbursement
• Curated Wellness Benefits supporting teammates physical and mental well-being
• Community engagement opportunities
• And more!

Responsible for initial triage of referrals, working with hospitals, facilities, engagement specialists, and the clinical team. Includes managing outbound calls, providing information on available network services, and preparing cases and transferring them to the appropriate clinical staff. Manages the referrals process, processes incoming and outgoing referrals, verification of facility telephone numbers, fax numbers, and if a member is being seen at a specific facility or by the specific doctor.
This role requires you to be on-site at our corporate headquarters in McLean, VA.

Responsibilities:

• Serve as primary support for clinical case managers.
• Extract and manage fax requests for medical or clinical service Outbound calls to providers to request clinical documentation, verify member information, request missing clinical documentation.
• Request clinical information via fax/email containing lab information and/or results.
• Access electronic member files using policy or id number.
• Determine member eligibility.
• Follow protocols to task requests appropriately.
• Reference automated job aid tools via the computer to identify appropriate procedures when needed.
• Review and interpret case history documentation.
• Navigate between computer screens and platforms to research information.
• Reference automated job aid tools via computer to research relevant rules, regulations, or procedures.
• Learn computer system and process changes and updates and incorporate into daily work.
• Contact internal resources if necessary to clarify information.
• Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests.
• Communicate with clinical team to ensure provider receives a response when necessary.
• Enter medical request data into relevant computer system.
• Follow standard procedures to complete requests.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Qualifications:

Required

• High School diploma or GED required.
• At least one year of medical records experience working in a healthcare setting.
• Basic computer skills (able to scan, organize and access electronic health records)
• Strong data entry skills with keen attention to details to ensure accuracy.
• Advanced organization skills
• Excellent time management skills
• Experience using Microsoft Office suite.

Other Duties : Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Somatus, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law. Further, the company takes affirmative action to ensure that applicants are employed, and employees are treated during employment without regard to any of these characteristics. Discrimination of any type will not be tolerated. IND

• Serve as primary support for clinical case managers.
• Extract and manage fax requests for medical or clinical service Outbound calls to providers to request clinical documentation, verify member information, request missing clinical documentation.
• Request clinical information via fax/email containing lab information and/or results.
• Access electronic member files using policy or id number.
• Determine member eligibility.
• Follow protocols to task requests appropriately.
• Reference automated job aid tools via the computer to identify appropriate procedures when needed.
• Review and interpret case history documentation.
• Navigate between computer screens and platforms to research information.
• Reference automated job aid tools via computer to research relevant rules, regulations, or procedures.
• Learn computer system and process changes and updates and incorporate into daily work.
• Contact internal resources if necessary to clarify information.
• Identify appropriate resource (e.g., doctor, resource, contracted provider) to respond to medical requests.
• Communicate with clinical team to ensure provider receives a response when necessary.
• Enter medical request data into relevant computer system.
• Follow standard procedures to complete requests