Job Description
Job Description
Referral Specialist
Job Summary : The Referral Specialist role with Choptank Community Health (CCHS) is essential in the management of the patient referral process and is a key link between the clinician, nursing staff, and the patient. The Referral Specialist must simultaneously maintain an efficient referral system, assist patients and clinicians on an individual basis and manage referrals on a systems level by monitoring referral reports and tracking referrals until closed Referral Specialist must have knowledge of the three factors by which all referrals are governed : payors and their insurance rules; providers and network participation, and primary care providers and their referring instructions. This is a nonexempt, full-time position in pay grade 2 with the pay range of $17.39 - $21.74. The Referral Specialist reports directly to the Practice Manager and / or Operations Director.
Required Skills / Abilities :
- Working knowledge of automated patient data systems.
- Must be proficient in computer skills.
- Must demonstrate the ability to use office equipment such as computers, printers, telephones, fax machines and copier machines.
- Working knowledge of Diagnosis and Procedure coding.
Education and Experience :
High School Diploma or equivalent1 – 2 years of medical experience preferred or completion of a career training program.Insurance billing experience helpful.Knowledge of basic medical terminology is required.Working Conditions and Physical Requirements :
General office environmentOccasional travelStandards of Behavior :
Commitment To ServiceRespectQualityTeamworkPatient FocusIntegrityAccountabilityCaring & CompassionProfessionalismListening & RespondingSafetyAIDETJob Related Competencies :
Empathetic Outlook- The ability to perceive and understand the feelings and attitudes of others; the ability to place oneself “in the shoes” of another and to view a situation from their perspective.Attention to Detail - The ability to process detailed information effectively and consistently.Problem Solving- Identifies and analyzes problems weighing the relevance and accuracy of available information. Generates and evaluates alternative solutions and makes effective and timely decisions.Communicates Effectively- Developing and delivering multi-mode communication that conveys a clear understanding of the unique needs of different audiences.Values And Ethics - Serving with integrity and respect in personal and organizational practices. Ensuring decisions and transactions are transparent and fair.Time Management- The ability to effectively manage one’s time and resources to ensure that work is completed efficiently.Commitment to Inclusion :
Choptank Community Health System (CCHS) is committed to creating an inclusive healthcare environment that reduces health disparities and values and respects the unique experiences and perspectives of both patients and staff by :
Prioritizing equitable access for individuals of all backgrounds, beliefs and cultures;Offering ongoing training for staff to promote health awareness, preventive measuresand early detection for a patient population of all backgrounds and cultures;Actively engaging with patients, families and staff;Fostering a workplace culture in which everyone is treated with dignity.Duties / Responsibilities :
Manages Referral ProcessConsistently processes and directs referrals according to payor requirements.
Consistently demonstrates ability to effectively prioritize referrals.Consistently troubleshoots problems and issues with completing referral and scheduling diagnostic and specialty appointments.Works with clinical staff to ensure that proper attachment of medical notes are included with the referral form.Counsels patients and provides instructions for specialty appointments,Documents in electronic health record and notify PCP. If the patient declines specialty care services.Keeps updated information regarding network and benefits for all payor groups.Ensures accuracy of referral form for completeness prior to submitting to insurance company and specialists’ office.Determines the length and number of visits allowed on referral forms.Oversight of Patient ComplianceManages a system that notifies clinician and documents when patient has "no-showed" for specialty appointments.
Reviews all open and due referrals at minimum on a bi-weekly basis.Contacts specialist office, diagnostic or imaging center to determine if patient kept appointment and requests medical record for all kept appointments.Consistently identifies patient access issues and communicates to PCP and Site DirectorPerforms Other Duties as RequiredPerforms Other Duties as RequiredPractices AIDET with all patient interactions.
Follows CCHS Standards of BehaviorTakes initiative to solve problems and recommends improvements to the Site Director.Consistently displays professionalism during interaction with CCHS customers, staff, and clinicians.Attends monthly site meetings, department meetings and full staff meetings as required.Promotes customer service with patients and outside contacts.Takes initiative and prioritizes effectively.Works with other staff to achieve a desirable working environment.Maintains inventory of office supplies by communicating low stock to designated person.Provides support to the department to cover shortages in other CCHS sites.Acts as back-up to Patient Services Specialist to cover department shortages.Provides phone support during peak times.Regular, reliable attendance is a requirement of this job.Benefits :
Tuition and education assistanceCertification scholarships availablePaid holidays (9)Flexible paid time off and vacation scheduling403(b)403(b) matchingEmployee assistance programFlexible spending accountHealth insuranceDental insuranceVision coverageLife insuranceReferral programEmployee wellness programDiscretionary BonusesPhysical setting : Office
Schedule : Monday to Friday (no weekends)
Job Type : Full-time
Choptank Community Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital or family status, veteran status, sexual orientation, gender identity or expression, genetic information, political affiliation, arrest record, or any other characteristic protected by applicable federal, state, or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
Salary : $17 - $22
