Referral Specialist

Job Summary:

The Referral Specialist will review, analyze and document all referral requests, obtain appropriate authorizations for all plans (managed care, Medicaid, Medicare) and coordinate the scheduling of the “referred to” specialty including communication with the Specialty Office and Patient.

Minimum Education:

High School Diploma or GED.
Licensure, Registration and/or Certification:
None.

Work Experience:

3 - 4 years related experience.

Knowledge, Skills and Abilities:

PC skills, customer service skills, organizational skills, communication skills.

Essential Functions and Responsibilities :
Daily queue accessed and analyzed to prioritize work to achieve optimal scheduling of patient for care. Includes research of referral to determine if all documentation is included necessary to process request and to assist in obtaining authorization if required for payment. Departmental protocols to be followed to ensure consistency in documentation in Epic as well as any communication to ensure completion.

Works with partner to ensure daily coverage. Communication with specialty staff/offices and diagnostic locations to ensure appointment date and time is arranged and communicate same to patients. Document appointment information for PCP office to ensure referral completion. Weekly and monthly accounting of referral queue aging to review and provide information about accessibility of patient care by specialty. Responsible to locate specialty physicians and maintain desktop reference information relating to assigned specialty to serve as knowledgeable resource.

Answer telephone calls from patients seeking new physicians. Determine match for patient based on geographic area, insurance and presenting medical problem(s) to facilitate patient care. Also serve as contact point for Warren Clinic office staff with 'same day' referral questions and inquiries about patient referral status. All staff share in telephone assignment and are responsible to be knowledgeable of resources.

Ensure that questions, potential delays and changes are brought to the attention of supervisor and/or manager for support and update of information to facilitate processing of referrals.
Decision Making:
The carrying out of non-routine procedures under constantly changing conditions, in conformance with general instructions from supervisor.
Working Relationships:
Works directly with patients and/or customers. Works with internal customers via telephone or face to face interaction. Works with external customers via telephone or face to face interaction. Works with other healthcare professionals and staff. Works frequently with individuals at Director level or above.
Special Job Dimensions:
None.