What are the responsibilities and job description for the Referral Specialist position at Columbia Eye Clinic?
JOB SUMMARY:
The Referral Specialist serves as a liaison between the referral source, Columbia Eye Clinic providers, and the patient.Along with ensuring timely access to care, it is the responsibility of the referral specialist to screen each prospective patient for active, in-network, and pre-authorization insurance needs.
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES FOR REFERRAL SPECIALIST:
- Handles all physician referrals quickly and accurately to ensure the treatment of ophthalmic services needed per referring physicians’ orders.
- Prioritizes work to ensure that urgent referrals are expedited.
- Uses ophthalmic clinical decision-making skills to determine the appropriate physician or sub-specialty needed based on the referral diagnosis or patient interview.
- Collaborates with physicians and physician technicians to ensure all referrals are processed accurately and efficiently.
- Ensures proper and accurate referral documentation (communication, actions, demographics, and other data) is entered on the tracking spreadsheet and in the patient’s electronic medical record.
- Contacts patient in a timely manner to schedule, confirm, and review all visit details (appointment date, time, location, and provider).
- Promptly responds to patient and referral source calls by returning the call that same day or next business day.
- Obtains and verifies that a patient’s insurance is active, in-network, and meets any pre-authorization requirements. When verified, enters insurance information into patient’s electronic medical record.
- Follows up with referring provider on patient care status.
- Informs patient to bring required paperwork and insurance cards, driver’s license etc. to appointment.
- Reminds patient to arrive 15 to 30 minutes before scheduled appointment.
- Provides excellent customer service by answering questions, addressing concerns, offering additional information, conducting research, etc. as requested or needed.
- Answers phones promptly and in a polite and professional manner
- Uses sound judgement in handling calls, especially with upset patients.
- Understands when to escalate calls to physicians/ manager/techs.
- Complies with all HIPAA and safety policies, procedures, and regulations.
- This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. To meet the business needs of the company duties, responsibilities, and activities may change at any time with or without notice.
EDUCATION AND EXPERIENCE:
- High School Diploma or GED and 1 year previous experience in a medical setting.
- Ophthalmic Technician experience highly preferred.
KNOWLEDGE, Skills, and Abilities for Referral Specialist
- Able to read and understand physician’s diagnosis on referral form to ensure appropriate care.
- Customer and patient service orientation: prompt response to patient needs and ability to manage difficult or emotional customer situations with tact, empathy and diplomacy.
- Strong communication and interpersonal skills.
- Competencies include excellent judgment, dependability, and diligence.
- High ethical standards and integrity.
- Strong organization skills with attention to detail, accuracy and thoroughness.
- Proficient in Microsoft office products.
- Proficient in reporting software
- Personal qualities of integrity, credibility, and commitment.
- Flexible and able to multi-task; works within a fast-moving environment.
WORKING CONDITIONS AND PHYSICAL EFFORT:
- Full-time position with a work schedule of Monday through Friday 8:00am to 5:00pm.
- Position operates in a professional office environment requiring minimal physical activity.
- Building meets required ADA standards and we will make reasonable accommodations to enable individuals with disabilities to perform the essential functions of the job.
- Physical demands include but are not limited to:
- The ability to sit, stand, walk, and use hands and fingers to operate a computer keyboard, mouse, and telephone to talk and hear.
- The ability to frequently sit and reach with hands and arms.
- The ability to occasionally lift and/or move up to 10 pounds.
- Manual dexterity for operating complicated equipment
- Must be able to utilize office equipment such as desktop/laptop computers, copiers, printers, scanners, telephones, and calculators.