Referral Specialist

Summary: Obtains verification and authorization for treatment as Primary Care Physician (PCP) deems necessary for continued patient care.

PROFESSIONAL KNOWLEDGE, SKILLS AND ABILITES:

• High School Diploma or GED.
• Basic understanding of medical terminology and documentation.
• Ability to use basic mathematical skills.
• Able to preform repetitive tasks.

ESSENTIAL DUTIES AND RESPONSIBILITIES: includes the following, other duties may be assigned.

• Assures all referrals are handled effectively and efficiently.
• Work priorities are set in order to accomplish tasks received by providers.

• Notify provider of any barriers to processing the referrals.

• Communicate with patients’ referral process and progress.
• Generate Referral.
• Contact insurance carrier for provider appropriate for patients insurance.
• Obtain clinical notes, labs images etc.
• Enter referral information into current practice management system.
• Fax referral and clinical documentation to provider office prior to appointment.
• Informs patients of their referral responsibilities.
• Request authorization.
• Process authorization request through insurance websites.
• Forward to specialty provider.
• Scan all documentation into patients chart.
• Close referral.
• Close referrals that have expired
• Follow-up on pending referrals to include sending letters to non-compliant patients.

• Ensure patient confidentiality and EMR security at all times.
• Maintain patient information within HIPAA guidelines.

• Keep other care team members informed when situations occur that disrupts timely patient flow through site.
• Consistently participates in and actively adheres to patient care expectations to attain clinical goals set forth in the PCHG Health Care Plans and the Quality Improvement / Quality Assurance (QI/QA)

SUPERVISORY RESPONSIBILITIES: None

GENERAL DEVELOPMENT:

• Maintains a professional relationship and positive attitude with co-workers, the public, patients and the entire organization.
• Maintains the highest professional and work ethics.
• Displays enthusiasm toward the work, mission and vision of the organization.

COMMUNICATIONS SKILLS:

• Exceptional Customer Service skills.
• Ability to communicate effectively, verbally and in writing.
• Excellent grammar, spelling and interpersonal skills.

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to lift 20 lbs. regularly and 30 lbs.-50 lbs. occasionally.
• Ability to sit for long periods of time.
• Direct exposure to computer screen.
• May be exposed to contagious/infectious diseases.

This job description in no way states or implies that these are the only duties to be performed by the employee(s) serving in this position. Employee(s) will be required to follow any other job-related instructions and to perform any job-related duties requested by any person authorized to give instructions or assignments.