Referral Specialist

Northern Light Mercy Hospital

Department: Physician Practice Central Ops

Position is located: Northern Light Home Care & Hospice So Portland

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: Variable

Summary:

The Referral Specialist provides administrative support to coordinate managed care referrals from primary care physicians, specialty outgoing referrals and ancillary services. Serves as a point person for all managed care issues. The incumbent performs duties and tasks in accordance with standards established for the job. The incumbent may have access to highly confidential patient, employee and/or proprietary information, and must handle & protect the information in accordance with hospital & system policies, HIPAA requirements and the highest level of ethical standards. The incumbent is responsible for reporting all security events, potential events, or other security risks to the organization. The incumbent is responsible for participation in and completion of all patient safety initiatives appropriate to the position, and conducts all job responsibilities according to the Mission and Values of Hospital.

Responsibilities:

1. Information Systems • Responsible for referral tracking (paper/computer/internet). • Handles lost/retroactive referrals to help eliminate billing problems for patients, insurance companies, PCP’s and Specialty office. • Organizes and maintains managed care reports as indicated. 2. Collaborates and works efficiently with members of the healthcare team. • Assists PCP/Specialty Provider in completing the referral accurately. • Liaison with insurance company, Office Manager, and PCPs. • Liaison between insurance companies and patients with resolutions to problems. • Schedules appointments, outside imaging for patients; completes referrals. • Sends reports and medical records pertinent to appointment to specialist in a timely manner.

Other Information :

Competencies and Skills

• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Education

• Required High School Diploma/General Educational Development (GED)

Working Conditions

• Potential exposure to abusive and/or aggressive people.
• Potential exposure to diseases or infections.
• Potential exposure to hazardous materials.
• Potential exposure to noise levels being uncomfortable.
• Potential exposure to noxious odors.
• Potential exposure to very hot or cold temperatures.
• Work with computers, typing, reading or writing.
• Lifting, moving and loading 20 to 30 pounds.
• Prolonged periods of sitting.

Portland, Maine, Catholic, Sisters of Mercy, Level 2 NeoNatal Nursery