Job Details

Job Summary:

Under the direction of the Referrals Manager, the Lead Referral Specialist is responsible for maintaining and processing referrals and related support services for staff and clinicians in our medical clinics. The Lead Referral Specialist monitors compliance with policies and procedures to assure goals and objectives for appropriate and timely processing of new incoming and internal, external specialty referrals are met. The lead Referral Specialist will provide overall direction on referral management and work with the Manager to incorporate new practices. While maintaining patient satisfaction and safety the Lead Referral Specialist works closely with all necessary departments to promote efficient and solidified processes throughout the organization.

Job Status: Full time, Hourly, Non-exempt

Reports to: Referrals Manager

Duties/Responsibilities:

• Participate in the development and implementation of necessary training to all Referral Care Coordinators (RCC’s)
• Participate in quality improvement (QI) processes for referrals department.
• Audits referrals for accurate documentation and completion and share findings with manager.
• Active participant in all referrals related meetings, workgroups and assigned committees.
• Reports and tracks monthly referral statuses.
• Performs quarterly workflow analysis for all RCC’s.
• Runs monthly reports on referrals productivity with Manager.
• Leads process improvement initiatives in Referral Management.
• Tracks all incomplete internal referrals and follows up with patients or scheduling staff until services are completed.
• Updates referrals workflow as needed to align with organization policies.
• Remains informed of all current and new changes in health plan referral processes.
• Coordinates incoming, internal and hospital follow up patient referrals in a timely manner.
• Sends tasks to appropriate staff members for scheduling of return approved referrals.
• Submits authorization requests to insurances; track the status of the authorization. Once approved, document procedure approval number and authorization period in the referral tracking system.
• Documents all client interactions in the EHR referral entry in a timely manner.
• Provides coverage for other referrals team members.
• Routes patient customer service requests to correct staff members to ensure proper completion.
• Safe keeps and updates insurance logins for referrals team.
• Manages clinic Electronic Medical Record (EMR) referral work queues daily.
• Communicates effectively with clinical team(s) and escalate to clinical team and/or supervisor when issues arise.
• Seeks assistance of supervisor when unable to process all referrals to avoid backlog and clinical consequences of delays.
• Accepts calls from physicians and/or their office staff, as well as health plans inquiries regarding referrals.
• Assist Referrals Manager during interview process for recruitment of new RCC staff.
• Handle all incoming calls for the department in a courteous manner, provide callers with an answer to their questions as best as possible.
• Ability to travel Understand the organizations commitment to provide high quality patient care.
• Develop understanding of programs such as but not limited to Excel, PPT, Microsoft Word, Tableau, Visio etc.
• Performs other duties as assigned.

Required Skills/Abilities:

• Ability to:
  • Make decisions guided by precedents, policies, and objectives.
  • Regularly makes decisions and recommendations on issues affecting a department or functional area.
  • Address problems highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and lean diagnostic techniques to resolve issues.
  • Set goals and determine how to accomplish defined results with some guidelines.
  • Provides guidance and overall direction.
  • Summarize and communicate in English moderately complex information in varied written formats to internal and external customers.
  • Comprehend and communicate complex verbal information in English to medical center staff, patients, families, and external customers.
  • Demonstrate in-depth knowledge of concepts, practices and policies with ability to use them in complex varied situations
  • Compassionately interact with patients to resolve any referral issues.
  • Empathize with others and defuse conflicts, handle crisis in a calm and respectful manner.
  • To understand, use and manage your own emotions.
  • Work with people of diverse populations.
  • Bilingual/Spanish preferred.