Referral Specialist

Job Description

Job Description

Referral Specialist

Full-time, 8AM to 5PM, Monday-Friday

Onsite

Areas of Responsibility: Ensure the effective management of all external and internal referrals. Schedule, follow-up, and complete referrals for clinic patients. Appropriately document referral progress in the Electronic Medical Record (EMR). Work with clinical staff to ensure appropriate scheduling, notifying the ordering provider when referral appointments are not kept, and preauthorization’s as required. Follow Patient-Centered Medical Home and Federal Tort Claim Act requirements to ensure patient safety.

Major Duties:

1. Play an active role in patient care using the provider led, Team-Based, Patient-Centered Medical Home Care Model.
2. Assemble information concerning patient’s clinical history and referral needs. Per referral guidelines, provide appropriate clinical information to specialists and exchange information with outside entities to verify prior authorizations for procedures.
3. Ensure referrals are addressed in a timely manner including sending referrals, scheduling, follow-up, and requesting and receiving records, completing referrals in the patient’s EMR.
4. Collaborate with Medical Support Staff (MSS), providers, and nurses to ensure a team-based approach to real-time referral tracking during each patient’s scheduled appointment.
5. Maintain ongoing tracking and appropriate documentation on referrals to ensure patient safety.
6. Complete Preauthorization of procedures with insurance companies.
7. Follow-up with the patient or external agencies per CAPWN Referral Tracking policy and procedures.
8. Review details and expectations about the referral with patients, including financial assistance programs that are available at the referral site.
9. Assist in training ordering providers and support staff.
10. Become knowledgeable of community and CAPWN resources.
11. Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.
12. Ensure that a patient’s primary care chart is up to date with information on specialist consultations, hospitalizations, ER visits and community organization related to their health.
13. Attend staff training sessions and meetings as required.
14. Maintain confidentiality of records and communications following CAPWN policy and HIPAA privacy and security policies and procedures.
15. Maintain CPR (Cardiopulmonary Resuscitation) Certification.
16. Maintain a positive and professional attitude, striving to openly communicate with co-workers and patients, breaking down communication barriers when necessar
17. As a CAPWN team member, dedicate your energy to providing high quality, value-added customer service and care to our clients. Embrace the CAPWN Standards of Behavior, practicing integrity, strong communication and respect for leaders and peers. Engage with the team and commit to improving and nurturing the health and well-being of the Western Nebraska Communities we serve.
18. Perform other duties as assigned.

Work Conditions:

• 90% office work, 10% training and meetings.
• Well-lit, temperature controlled clinical setting, with standard medical and office equipment available.
• Work can be stressful and requires ability to meet tight timelines and flexibility of changes in daily routine.
• Able to concentrate within the everyday distractions of a medical office/business.
• Able to work independently, analyzing and assessing workflow and turnaround times while following established policies and procedures with minimal supervision.
• Able to understand technology of clinical software.
• The noise level in the work environment is usually average.

Physical Requirements:

• Ability to bend, stoop, walk, lift and sit.
• Ability to sit and /or stand for long periods of time.
• Occasionally lifting and carrying up to 25 pounds.
• The position requires sedentary work, with use of headphone, keyboard and video display terminal.
• Need excellent listening skills, excellent eye, hand, auditory coordination and finger dexterity.
• Must regularly talk, hear and have close vision ability to record and communicate appropriate documents and records.

Minimum Qualifications:

Grade: 12

1. Strong customer service skills

2. Ability to work alone and unsupervised

3. Two years of experience in a health care clinic, referral processing preferred

4. Have a working knowledge of HIPAA Privacy Regulations, maintaining confidentiality in the provision of all services including written and/or oral reports

5. Requires proficient level of oral and written communications with proven skills in grammar, punctuation, style, and editing

6. Have a working knowledge of Microsoft Office and Adobe programs

7. Organized and able to manage competing priorities

5. Successful completion of Medical Terminology course or equivalent, preferred

Grade: 13

1. Must meet minimum qualifications above with;

2. Completion of coding course or equivalent

3. Three years of experience in health care setting

Grade 14

1. Must meet minimum qualifications above with;

2. Associate’s Degree OR

3. Five years of experience in a healthcare clinic setting