Referral Specialist

Overview

The Referral Coordinator reports to the Prior Authorization Supervisor. Under the general supervision, coordinates the effective and efficient patient flow regarding pre-registration scheduling appointments with specialist and testing per physician request. Obtains proper insurance authorization prior to scheduling appointment and once completed contacts patient with pertinent information and ensures that all required information is forwarded to specialist office following practice protocols.

Follows patient’s status within the cycle of provider care to ensure continuity of services utilizing Life Chart referral work queues. Functions as a liaison between the hospital and patients to facilitate the solution of patient financial issues concerning outpatient registration. Coordinates the effective and efficient processing and scheduling of all incoming referrals, adhering to established timelines and departmental procedures.

Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

• Instill Trust and Value Differences
• Patient and Community Focus
• Collaborate

• Preregister/schedule/coordinate/triage all referrals created by and sent to the practice via Life Chart work queues.
• Set follow-up alarms per practice protocols and the tracking function to ensure that all outstanding referrals are followed‑up on.
• Monitor/update pre and post registration work queues.
• Obtain all un‑resulted consults and testing orders managed by the referral office.
• Alert the ordering provider of any patient that does not keep an appointment with a specialist or testing facility.
• Receive and review all incoming referrals ensuring completeness and accuracy.
• Ensure all information is received including patient demographics, insurance and authorizations.
• Communicate promptly with referring provider and/or patient regarding insurance coverage issues (e.g. non‑participation status) so the patient may seek timely services elsewhere.
• Maintain current knowledge of insurer referral authorization requirements and have a working understanding of the patient population and demonstrate cultural awareness and sensitivity.
• Document any communication with referring providers, patients and/or clinic (MD, RN, etc.) in the EHR.
• Collaborate with social work, Patient Financial Advocate and Patient Navigator for financial assistance and eligibility.
• Participate in practice performance and quality improvement activities.
• Attend required meetings and trainings as directed.
• Perform other related duties as assigned.
• Consistently monitor clinic schedules to ensure maximized scheduling and fill any available/open timeslot including those appointments cancelled and/or rescheduled.
• Notify provider and/or supervisor if unable to schedule referral or if there are access issues.
• Monitor referral work‑queues and ensure that all referrals have been processed accordingly.
• Apply front‑office and clinical knowledge for triaging referrals and determine when the patient needs to be seen.

• High school degree or the equivalent. Billing and medical knowledge preferred.
• Two years of clinical referral experience preferred.
• Data entry skills and computer experience required.
• Strong customer service focus.
• Effective verbal and written communication skills.
• Organized and able to manage competing priorities.
• Ability to take and follow through with delegated tasks and accountability.
• Demonstrated knowledge and skills necessary to provide care to patients throughout the life span with consideration of aging processes, human development stages, and cultural patterns in each step of the care process.
• Performs independently within department policies and practices.
• Refs specific complex problems to physician practice manager when clarification of departmental policies and procedures may be required.

$17.00‑$25.82

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

East Providence-375 Wampanoag Trail - 375 Wampanoag Trail East Providence, Rhode Island 02915

8:00a‑4:30p

Day

8 hours

Yes