Referral Representative

Referral Representative completes customer service tasks that ensure patients and providers have the information and assistance they need and maintain the Organization’s positive reputation. 

What makes a good Referral Call Representative?

An effective Referral Call Representative should be great at and willing to listen, as they must regularly listen and empathize with a patient to show they care about their problems and are working to resolve them. Strong Referral Call Representative candidates are also able to handle pressure well, as they may have to handle customers who are frustrated and discouraged about their referral. It’s important for Referral Call Representatives to have positive attitudes to make patients and providers feel better by the end of the conversation.

Benefits:

• Free Medical, Dental & Vision
• 13 Paid Holidays PTO
• 403 (B) retirement match
• Life Insurance, EAP
• Tuition Reimbursement
• SEIU Union 
• Flexible Spending Account
• Continued workforce development & training
• Succession plans & growth within

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education Requirements:

• High School Diploma or equivalent

Experience and Skills (Required)

• 2 years in healthcare and call center setting 
• Bi-lingual English/Spanish 
• Proficient Microsoft office and Excel
• Medical Terminology
• EHR- Electronic Health Records
• Strong customer service focus
• Effective verbal and written communication skills
• Teamwork orientation
• Organized and able to manage competing priorities.
• Good judgment
• Resourcefulness in problem solving.
• Strong communication, both written and verbal
• Great active listening skills
• Exceptional interpersonal and rapport building skills.
• A patient and empathetic attitude
• Strong time management and organizational skills
• Adaptability and flexibility
• Comfortable working in fast-paced environments
• Troubleshooting skills, either basic or advance, for both Authorizations and Records roles
• Computer literacy

Essential Duties & Responsibilities

Performs a combination, but not necessarily all, of the following duties:

• Take customer calls and provide accurate, satisfactory answers to their queries and concerns.
• Handle high volume of incoming /outgoing calls and provides excellent customer service.
• De-escalate situations involving dissatisfied patients, offering patient assistance and support.
• Guide callers through troubleshooting, navigating the Organizations patient’s web portal.
• Modifies CPT/ICD-10 Codes and extends authorizations as needed.
• Access patient medical records and verifies eligibility via Medi-Cal/Medicare, Health Plans web portals (e.g., eConsult, LANES, Medpoint Management, OPTUM, etc.)
• Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
• Will attend meetings and training at collaborative and partnership events.
• Serve as clinic liaison to outside agencies and partners.
• Communicates with internal staff using Microsoft Teams, Emails, etc.
• Back-up to the Microsoft Teams “Referral Inquiry Chat” channel inbox
• Assist the Referral Helpline calls as needed.
• Uses medical terminology on regular basis for doctors and vendors.
• Interacts with entities (IPA, Health Plans etc.) Medical Management staff including Medical Directors and St John’s Heath services Network, Clinic Manager, and other staff.
• Acts as a Provider educator to assure that the Provider is aware of referral timeframes and communicates referral information to patient regarding his/her condition and patient is educated. 
• Performs/Assist with all other external specialty referral records related duties.
• Able to cope in a “fast pace” work setting.
• Assist/managing patient portal Referral Inbox queue.
• Responsibilities are subject to change at the Manager’s discretion.
• Able to work Saturdays and travel to Clinic Sites as needed.

St. John’s Community Health is an Equal Employment Opportunity Employer