Referral Specialist- Patient Service Center Lee County

ALBANY AREA PRIMARY HEALTH CARE, INC. 

JOB DESCRIPTION 

REFERRAL SPECIALIST 

JOB SUMMARY 

Works under the direction of the Chief Quality Officer and part of the Quality Department to ensure coordination between internal and external resources is handled appropriately to ensure quality of care to the patient.  This individual will act as the first contact for referring physicians’ offices and new patients related to the referral process.  

JOB CLASSIFICATION: 109     

DUTIES AND RESPONSIBILITIES 

1. Daily, check the referral log from the previous day and maintain that log in a timely manner. Referrals should be completed within 30 days. 

1. Call patients back with referral information promptly 

1. Document the referral cycle in the appropriate location 

1. Obtain authorizations as needed and required 

1. Answer the phone and handle call appropriately 

1. Resolves pre-certification, registration, and case-related concerns prior to a patient's appointment 

1. Responsible for verifying and securing authorizations/referrals for all visits and coordinating all outside referrals, appointments, and authorizations for outside diagnostic testing and other services. 

1. Responsible for scheduling, tracking, and communicating with patients to ensure completion of all physician referrals. 

1. Provide timely feedback to provider if referral appointment is not kept 

1. Ensure that documentation is received back into patient’s medical record for all diagnostic testing and outside referral services 

1. This individual is responsible for expediting the administrative requirements for the patient referrals in the clinic, ensuring that appropriate referrals are made to participating providers; with the patients' health plan 

1. Understands and follows HIPAA requirements; conducts clinical/business processes that ensure patient’s rights to privacy and confidentiality as a priority 

1. Women Health Clinic ONLY: (Scheduling Surgeries)  

1. A. Refer and schedule patients for specialized testing, Cesarean deliveries, inductions, surgery, etc.  

1. Track and monitor surgery appointments. Also schedule and obtain pre- authorization from patient’s insurance carrier for surgeries.  

1. Schedule all surgeries: Communicate with hospital representative to schedule procedures at facility and communicate with patient pre-operative instructions.  

1. Interact with operating room staff to ensure proper scheduling and any cancellations or changes in the schedule.  

1. Work with other departmental schedulers within the hospital to effectively coordinate procedures based on availability of physician.  

1. Maintain daily surgery schedule for physicians.  

1. Accurately completed and pre-cert surgery case prior to surgery date.  

1. Schedule and facilitate all patient appointments required prior to elective surgery. 

1. Ensure patient is educated on Financial Obligation prior to surgery.  

1. Answer phones, maintain and provide accurate information for the hospital and the patient.  

EDUCATION, EXPERIENCE, AND SKILLS 

High school graduate 

Prior medical office experience required; MOA preferred 

Prior training in customer service and public relations highly desirable