Referral Specialist

GENERAL DESCRIPTION:

Timely and accurate processing of incoming and outgoing referrals; responsible for providing health center patients with specialty care/referral options; respond to inquiries from patients, staff, internal and external physicians, hospitals, other medical groups and third party carriers; maintain data and referral tracking system; work collaboratively with other members of the patient care team to support superior care delivery and excellent customer service.

STANDARD RESPONSIBILITIES:

1. Supports the Mission, Values and Vision of Community Health Centers of Pinellas, Inc.

2. Is accountable to ensure patient rights and ensures an environment that promotes the privacy, dignity and well-being of all patients in a safe, secure environment.

3. Supports, cooperates with, and implements specific procedures and programs for:

a. Safety, including universal precautions and safe work practices, established fire/safety/disaster plans, risk management, and security, reports and/or corrects unsafe working conditions, equipment repair and maintenance needs

b. Confidentiality of all data, including patient, employee and operations data

c. Quality Improvement and compliance with all regular requirements

d. Compliance with current law and policy to provide a work environment free from sexual harassment and all illegal and discriminatory behavior

4. Supports and participates in common teamwork:

a. Cooperates and works together with all care team members, plans and completes job duties with minimal supervisory direction, including appropriate judgment

b. Remain calm and poised in urgent or stressful situations

c. Follows up as appropriate with supervisor, care team members or patients regarding reported complaints, problems and concerns

d. Promotes positive public relations with patients, visitors and the community

e. Completes requirements for in-service training, acceptable attendance, uniform and dress codes including personal hygiene

f. Ability to work with persons from a wide diversity of social, ethnic and economic backgrounds

g. Effectively and efficiently completes all duties as assigned

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Demonstrates the positive behaviors that reflect understanding and support of the organizational mission, values, visions, quality philosophy and process

2. Demonstrates knowledge of and compliance with established organizational policies and procedures

3. Processing of times sensitive orders/referrals to appropriate insurance carriers for authorization within established guidelines

4. Daily review of pending authorizations, referral issues and tasks as per guidelines

5. Elevating authorization delays to the referral supervisor or designee and to the patient per protocol

6. Maintains organized workflow

Referral Specialist Job Description

Revised 6/2016

7. Participates in quality improvement process

8. Accurate and timely documentation and scanning into the electronic health record indicating the authorization process was followed to completion

9. Proficient in documenting patient data into electronic health record

10. Daily faxing to specialists, insurance carriers and providers; timely scanning of documents per established

Guidelines

(These essential job functions are not to be construed as a complete statement of all duties assigned. Employees will be required to perform other job related marginal duties as required.)

SUPERVISORY RESPONSIBILITIES: None

EDUCATION:

• High School Diploma or GED certificate

• Some college preferred

LICENSES/CERTIFICATIONS: None

EXPERIENCE:

• One year experience in a healthcare setting

• Medical Assistant Certification preferred

SPECIFIC SKILLS REQUIRED:

• Knowledge of insurance billing; medical terminology

• Experience with eligibility and screening procedures for individual insurance companies

• Excellent customer service

• Critical thinking

• Excellent written and verbal communication skills

• Computer Usage/Windows Literacy; Microsoft Work/Excel or equivalent

• Ability to navigate and enter data into an electronic health record

• Mathematical skills

ESSENTIAL PHYSICAL SKILLS:

• Able to walk, stand, talk, use hands to finger, handle or feel, reach with hands and arms, climb and descend steps, carry or lift up to 25 lbs., stoop, kneel, crouch and/or crawl.

• Able to read up close or at a distance, identify and distinguish colors, have peripheral vision (up, down, left, right, while eyes are fixed on a given point), and have depth perception (3-dimensional vision, judge distance and spatial relationships).

• Able to communicate, verbally and in writing with patients, vendors and/or co-workers

Reasonable accommodations will be made for otherwise qualified individuals with a disability.

ENVIRONMENTAL CONDITIONS:

Moderate business office noise, i.e., computers, printers, typewriters, calculators, telephones, fax machine, etc.

Regular exposure to individuals with communicable disease(s), germs and potentially toxic fluids and blood borne pathogens.

I have read and understand the aforementioned functions and responsibilities and agree to maintain satisfactory job performance in all areas.