What are the responsibilities and job description for the Referral Specialist position at Community Clinic of Maui, Inc.?
Brief Description
Help connect our Maui community with the care they need! Malama I Ke Ola Health Center is seeking a compassionate, detail-oriented Referral Specialist to help patients access specialty care and services. In this essential role, you’ll collaborate with providers, specialists, and insurance companies to coordinate appointments, secure authorizations, and keep referrals moving forward. If you have healthcare experience, strong organizational skills, and a commitment to following through for patients, we’d love to hear from you!
PRIMARY FUNCTION: Responsible for referring and authorizing patients to specialists and services not provided within the clinic. Collaborates daily with insurance companies and physician offices to obtain services for Malama I Ke Ola Health Center patients.
Position Requirements
Help connect our Maui community with the care they need! Malama I Ke Ola Health Center is seeking a compassionate, detail-oriented Referral Specialist to help patients access specialty care and services. In this essential role, you’ll collaborate with providers, specialists, and insurance companies to coordinate appointments, secure authorizations, and keep referrals moving forward. If you have healthcare experience, strong organizational skills, and a commitment to following through for patients, we’d love to hear from you!
PRIMARY FUNCTION: Responsible for referring and authorizing patients to specialists and services not provided within the clinic. Collaborates daily with insurance companies and physician offices to obtain services for Malama I Ke Ola Health Center patients.
Position Requirements
- Good organization, documentation and tracking skills.
- Computer literate and able to establish tracking and follow-up systems of referrals.
- Excellent interpersonal and communication skills. Able to relate to providers, patients, insurance companies and other medical providers effectively.
- Basic skills in working with diverse and marginalized populations.
- Attunement to ethical and legal standards of care.
- Arranges patient’s consultation with specialists.
- Contacts specialists and arranges appointment.
- Arranges secondary or subsequent referrals made by initial specialist.
- Obtains authorization for in-hospital consultations made by CCM providers.
- Obtains authorization for patients with same day appointments with another provider.
- Obtains from insurance companies, reauthorization of expired referrals for missed appointments or follow-up visits.
- Coordinates with insurance companies, air/ground transportation for patients needing referral to Neighbor Island.
- Obtains authorization for patients who have moved to Neighbor Island and are establishing care with a new PCP.
- Obtains authorization for surgeries and procedures.
- Obtains approval for patients who are changing PCP to CCM.
- Tracks referrals and ensure timely submission of consultation reports.
- Coordinates referrals with nursing staff.
- Trains nursing staff on referral coordination.
- Makes every reasonable effort to provide referrals as quickly as possible and minimizes patient wait time to receive referrals and authorizations.
- Ethics and Law
- Demonstrates a strong commitment to adhering to ethics, with special attention to dual relationships, confidentiality, informed consent, limits of competence, and team functioning.
- Follows state laws, especially with regard to abuse reporting, adolescent reproductive health, and determination of decision-making capacity.
- Timely documentation submission as soon as possible and within 24 hours from the patient encounter.
- Team and Interpersonal Skills
- Demonstrates strong conflict resolution skills.
- Understands and follows the organizational structure and reporting lines when addressing problems.
- Possesses mindfulness skills, strong self awareness, and emotional management in a team environment
- Able to establish, maintain, and promote strong and cooperative working relationships with all staff.
- Attends and participates in meetings and quality improvement activities as required.
- Serves as a member of committees as requested.
- Monitors CCM’s behavioral health program, identifying problems related to patient services and making recommendations for improvement.
- Furthers the mission of the organization through active support of the strategic goals and CCM values.
- Safety and Compliance
- Attend all required in-service and external training related to Safety and Compliance.
- Read, watch safety & health videos, and adhere to all policies and procedures in Safety and Health Guidebook.
- QUALIFICATIONS
- Healthcare background with knowledge of clinical procedures, terminology and healthcare resources.
- Good organization, documentation and tracking skills.
- Computer literate and able to establish tracking and follow-up systems of referrals.
- Excellent interpersonal and communication skills. Able to relate to providers, patients, insurance companies and other medical providers effectively.
- Basic skills in working with diverse and marginalized populations.
- Attunement to ethical and legal standards of care.
- TB clearance within the last 12 months
Experience/Skills