Job Description
Job Description
The Referral Specialist performs general functions including reviewing and processing of all medical orders. Referral Specialist also ensure the order is covered by patient’s health plan, as well as within organization standards. In addition, the Referral Specialist provides patients with updates on submitted orders. The Referral Specialist provides excellent quality care, positive customer service, the maintenance of an efficient and safe environment of care. Demonstrates superior customer service skills and has the ability to function in a multi-tasking, multiple priorities environment, while maintaining accuracy and attention to detail.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Tracks, monitors, and verifies insurance eligibility in a timely manner for all medical orders as well as ensuring order meets meeting organizational standards.
- Complete prior authorizations, if needed for orders.
- Functions as contact between Aunt Martha’s Health and Wellness to provide patient with status of orders.
- Acts as a liaison between patient and referring agency to ensure patient is provided with prompt and effective patient care.
- Collaborate with health plans, specialists, hospitals, and physicians to ensure completed referrals.
- Communicate with patients by phone and/or mail regarding the status of order submitted by clinic (referral, diagnostic order, surgery request and transportation.)
- Scan and file in patient’s HER file all results/communication received from specialist or hospitals.
- Maintain patient confidentiality at all times per the policies and procedures.
- Maintain ethical behavior at all time per the policies and procedures.
- Responds to internal and external customer needs in a positive manner, utilizing principles of the AIDET model; exceeding their needs and expectations and providing the highest quality service to ensure the best possible outcomes.
- Master the electronic health record system, Athena, to appropriately document patient data and information.
- Answers designated telephone calls in a courteous manner, appropriately routes communication, responds to inquiries and transcribes messages.
- Attend all trainings and meetings as required by the program.
- Complete all Core Curriculum training(s) required for this position.
- Perform all other duties as assigned.
KEY COMPETENCIES:
- Dependable and reliable giving extra effort when necessary to accomplish Aunt Martha’s Health & Wellness goals.
- Takes initiative to proactively recognize problems/opportunities and develop appropriate strategies to deal with them.
- Ability to manage multiple and competing demands and establish priorities. Ability to learn quickly and adapt to change in processes and organization.
- Makes data driven supported decisions wherever possible considering all relevant facts.
- Ability to work independently and as part of a collaborative team in order to meet health division goals and priorities. Acts cooperatively and contributes to teamwork. Willingness to act as a strong team player and bring an optimistic level of energy to the team.
- Maintains professional, technical and technological proficiency in all aspects of the job.
- Excellent oral and written skills. Communicates decisions promptly, clearly.
- Excellent organizational skills and attention to detail, deadlines and program compliance.
BENEFITS:
- Health, Dental, and Vision Insurance
- Disability & Life Insurance
- Paid Vacation, Sick Days, and Holidays
- Retirement Plan
- Employee Assistance Program (EAP)
- Employee Discounts on services like cell phones, restaurants, and more
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
EDUCATION and/or EXPERIENCE
- High school diploma or general education diploma (GED) required and at minimum six-month experience in a medical office
- Experience in working with Microsoft Office programs essential; adept at data entry
LANGUAGE SKILLS
Ability to speak, read and write English. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Bilingual skills (English/Spanish) a plus
MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
REASONING ABILITY
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
OTHER QUALIFICATIONS
Current driver’s license
Current auto insurance
Ability to work late evening hours, weekend hours, and scheduled holidays, as needed
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to stand and walk. The employee is occasionally required to climb or balance; stoop, kneel, crouch, or crawl; and taste or smell. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
WORK ENVIRONMENT:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
While in the clinic, there may be some exposure to communicable disease, body fluids, toxic substances, medicinal preparations, radiation and other conditions common to a clinical environment. The noise level in the work environment is usually moderate.
ORGANIZATION-WIDE EXPECTATIONS:
- All employees are expected to adhere to Aunt Martha’s mission, vision and guiding principles.
- All employees are expected to adhere to all Agency and Division/Department policies and procedures.
- All employees are expected to maintain all required competencies, registrations; certifications, licenses and personnel file documentation as required by the agency, funders and/or accrediting bodies.
- All employees are expected to embrace diversity, treat our patients and co-workers with dignity, respect, and hold others to these standards.
- All employees are expected to uphold the confidentiality requirements of all patient records consistent with HIPPA, State, and Federal laws and regulations