Referral Specialist I

J  o  b    D  e  s  c  r  i  p  t  i  o  n

          Joy                         Care                      Competence                    Respect

Position Summary

Reviewing scheduled services of ancillary, specialty services or procedural referrals submitted throughout the division to determine authorization needs. Accurate documentation of process details and data received to ensure services are completed. Coordination of treatment plan with clinical teams, treating facilities and patients or their care givers. Accurately and efficiently handle multi-line requests from internal and external customers.

High School Diploma or equivalent is required

1-2 years of healthcare or clerical/administrative experience is required.

1-2 years of customer service experience is required.

1-2 years of call center experience is preferred.

1-2 years of clinical experience is preferred.

Certified Medical Assistant is preferred.

Demonstrated strong verbal and written communications skills.

Ability to problem solve using provided materials.

Dedicated to quality and commitment to task resolution.

Demonstrates excellent judgment and decision-making skills.

Ability to simultaneously handle multiple priorities.

Highly thorough and dependable.

Friendly and service oriented.

Knowledge of or ability to learn basic medical terminology.

In accordance to the patient’s insurance plan and the ordering provider recommendations or patient preference the Referral Specialist determines the next line of care for the patient.

Verification of insurance authorization is obtained and documented in the patient’s chart prior to the scheduled ancillary or specialty service being rendered to the patient.

Initial coordination or rescheduling patient appointments of ancillary and specialty services within the local hospital ministries, external facilities, and internal clinics when necessary.

Maintains accurate and detailed documentation in the EHR.

Research patient’s chart to determine the appropriate records to associate with specialty referrals.

Responds to clinical and hospital colleagues through multi-line communication methods in order to facilitate the administrative components of a referral.

Follows up with external referrals to determine if a date of service has been scheduled in accordance to the workflow and documents the EHR accordingly.

Receives incoming reports from external facilities and inputs the data into the EHR appropriately in accordance to the workflow.

Maintains accurate status in the phone queue.

Fax copies of medical records to the payor, treating facility or specialty office as required. Ensuring the treating provider or facility received the referral and is prepared to schedule.

Maintain ongoing communication between hospitals, treating provider and the patient or patient contact which is documented in the EHR.

Meets goals related to quality and patient satisfaction by providing quality customer service when aiding colleagues, patients or their caregivers, or internal/external customers while coordinating patient care.

Possess the information, skill, and understanding of the work to be performed.  Actively participates in continuing education opportunities and maintains certifications, licensure as appropriate.

Abides by all safety requirements including demonstrating proper hand hygiene and wearing of Personal Protective Equipment (PPE), if applicable. 

Complies with all standards, policies and procedures including dress code, attendance and punctuality.  Attends required in-services and meetings and completes all mandatory competencies by deadline. Commits to keeping all patient, student or colleague information confidential and maintains ongoing communication and collaboration with team members. 

The purpose of this job description is to provide a summary of the major responsibilities performed by colleagues in this position. Colleagues may be requested to perform tasks other than those specifically presented in this job description.  Variances in job duties performed may exist between facilities, and colleagues may perform other related duties as assigned to meet the needs of the organization.

PHYSICAL, MENTAL AND ENVIRONMENTAL REQUIREMENTS

Physical, Mental and Environmental Requirements Category:

Administrative

Standing

X

Walking

X

Sitting

X

Lifting

X

20 lbs.

Carrying

X

20 lbs.

Pushing

X

20 lbs.

Pulling

X

20 lbs.

Climbing

X

Balancing

X

Stooping

X

Kneeling

X

Crouching

X

Crawling

X

Reaching

X

Use of Hands/Dexterity

X

Talking

X

Hearing

X

Eye/Hand/Foot Coordination

X

Extreme Cold

X

Extreme Heat

X

Humid

X

Wet

X

Noise

X

Hazards

X

Temperature Change

X

Atmospheric Conditions

X

Vibration

X

Other