Description

United Family Medicine (UFM) is a Federally Qualified Health Center in St. Paul, where patients receive community-based Family Practice medical care in addition to mental health, dentistry, social work and other integrated services. When joining UFM, you become part of a diverse, inclusive, and welcoming team who are dedicated to serving our patients and pursuing our mission to deliver excellent healthcare for all and training for the providers of tomorrow.

JOB SUMMARY:

The Referral Specialist is responsible for obtaining authorizations or referrals for visits, testing, surgeries, and other healthcare services. This position also includes but is not limited to monitoring outcomes to ensure establishing and maintaining effective procedures for managed care referrals. The Referral Specialist will assist all departments: dental, medical, behavioral health, diabetic education/dietician, and podiatry. The Referral Specialist will ensure that all referrals are closed using the Closed Loop Method.

ESSENTIAL FUNCTIONS:

Administrative Duties:

• Assist patient scheduling of outgoing referrals to other clinics.
• Assist patient scheduling with internal referrals.
• Submit insurance referrals and communication with payers (Obtain prior authorization for services and procedures – restricted recipients, prior authorizations and insurance referral).
• Fax/transmit diagnostic imaging and physical therapy orders.
• Manage/addend orders for tests as needed.
• Update referral requests with documented date, time, and location.
• Partner with Financial Navigator as needed.
• Navigate specialty care for uninsured patients.
• Partner with CHWs for community resource needs.
• Manage incoming calls from patients, clinics, and additional referrals.
• Act as a resource for clinical staff and providers on community and healthcare referrals.
• Ensure that the referrals work pool is monitored daily (ie. patient calls, staff messages, scanned documents and cc’ed charts).
• Closed Loop Method: make follow-up calls to referral location, ensure a consult report has been received and close referral order.
• Ensure that referrals are addressed in a timely manner.
• Flexibility to cross train to CHW, Medication Prior Authorization and Scheduling.
• Maintain strict confidentiality; adheres to all HIPAA guidelines/regulations.

Customer Service:

• Answer phone calls from patients and insurance companies.
• Return phone calls in a timely manner.
• Assist patients in problem-solving potential issues related to the referrals.
• Correspond with patients and/or providers as needed regarding care coordination.

Perform other tasks as assigned.

Requirements

KNOWLEDGE, SKILLS, AND ABILITIES:

• Strong customer service skills.
• Excellent written and verbal communication abilities.
• Ability to work independently or on a team.
• Skills in identifying problems, problem solving and resolution.
• Ability to analyze patient accounts.
• Knowledge of medical procedures and medical terminology.
• Knowledge of medical insurances (Medicare, Medicaid, HMO’s, PPO’s, commercial), EMTALA regulations, hospital/clinic billing and collection process
• Demonstrate sound judgement and decision-making abilities.
• Ability to prepare and maintain detailed records, files, reports, and other correspondence.
• Ability to establish and maintain effective communication.
• Ability to perform the job in accordance with United Family Medicine’s Standards of Business Conduct, which includes compliance, ethics and integrity, confidentiality, protection of assets and avoidance of conflicts of interest and inappropriate business relationships. Specifically, work processes that involve billing/collections practices for avoiding activities that constitute fraud and abuse.
• Excellent time management skills with the ability to prioritize workflow and meet stringent deadlines.
• Basic computer skills.
• Strong keyboard skills.

EDUCATION/EXPERIENCE:

• High School Graduate or GED is required.
• Two years post high school education or degree preferred.
• Minimum two (2) years of business office experience is preferred.
• Minimum two (2) years of experience in referral management or insurance managed care environment, preferred.
• Bilingual/fluent in English and Spanish is strongly preferred.

CERTIFICATES, LICENSES, REGISTRATIONS:

N/A

PHYSICAL DEMANDS:

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

WORK ENVIRONMENT:

Work is performed in a clinic office environment. Contact with staff, patients and outside agencies. Possible exposure to communicable disease and medical preparations common to clinic environment.

SUPERVISORY RESPONSIBILITIES:

None

Beginning January 4, 2022, all job offers are conditioned on the candidate being fully vaccinated against COVID-19 with a vaccine authorized for emergency use or FDA-approved. A person is only considered “fully vaccinated” two weeks after receiving a single J&J vaccine or a second Pfizer or Moderna vaccine shot.

In addition, job offers made during flu season are conditioned on the candidate receiving the annual flu vaccination before their start date.

 UFM is an equal opportunity employer.