Referral Specialist

Job Description

Job Description

Description : Position Overview :

The Referral Specialist is responsible for coordinating care for patients between external providers and organizations (e.g. other physician offices, community service agencies, and hospital / emergency facilities) and for providing high quality referrals and transitions; ensuring that all involved providers, facilities, and patients have the information and resources needed to coordinate care for the patient. Reviews clinical data to report medical necessity to insurance companies and establishes relationships and agreements among providers that lead to shared expectations for communication and care. Performs all work with accord to the vision, values, and culture of Brio Primary Care. These duties will require approximately 40 hours per week. Candidate must reside in the Greenville, SC area and be expected to attend in person meetings, trainings, etc. Initial job training will be in-person at Bella Grove location.

Responsibilities :

• Sends outgoing referrals to specialist offices.
• Ensures that patients are scheduled in a timely manner consistent with diagnosis and level of care needed and communicates appointment information with provider.
• Assumes accountability and develops connectivity via electronic or other modes of communication to promote timely and effective information flow between providers (including community agencies).
• Follows up with specialist offices to gain consult notes / medical records & coordinate continuation of care.
• Gains insurance pre-certs and authorizations as needed for referrals and diagnostic imaging.
• Analyzes, recommends, implements, and monitors approved workflow changes for procedures and protocols.
• Maintains accurate and up-to-date referring physician directory and provides providers with any relevant updates and changes.
• Schedules all STAT appointments.
• Follows up to obtain results and documentation.
• Promotes excellent relationships between Brio Primary Care and specialty offices.
• Works to improve processes that will be beneficial for both internal and external parties, which will build Brio's rapport in the medical community.
• Takes ownership of ensuring all Brio patients, families, caregivers, external specialty offices, community, and internal team members experience the Brio Way.
• Promotes an authentic and transparent work environment.
• Follows up to be sure that patients are keeping their ongoing appointments.
• Works with the billing department and providers to verify that consult and referral visits are coded appropriately.
• Other duties as assigned.

Requirements : Education :

Skills / Experience :

Environmental / Working Conditions : Ability to work in an environment with exposure to potentially dangerous / infectious materials and situations that require following extensive safety may be required and / or hours may be shortened as business needs dictate.

Physical Demands : Ability to perform moderate physical activity. May require handling / lifting objects (up to 50 pounds) or standing / sitting / walking for more than four (4) hours per day.

Prolonged use of the telephone may be required.