Referral Specialist

JOB SUMMARY

The centralized Referral Specialist processes referrals, receiving all in-coming correspondence, telephone calls and faxes related to the referral process; processes all referral requests using the Standard Operating Procedure developed by the Referral Department; participates in a team-based approach to care in the Patient Centered Medical Home (PCMH); participates in activities related to Quality Improvement.

ESSENTIAL JOB DUTIES

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Answers incoming departmental calls, ensuring that all calls are handled or routed as appropriate. (10%)
2. Processes the insurance company authorization per the preferred method (electronic, fax, telephone) for any referral requiring prior authorization. Notifies specialist office or testing facility of prior auth approval/auth number if required. Ensures that all authorizations are communicated to entities applicable in the process, and that relevant documentation is shared according to established practices within GLBHC guidelines. (45%)
3. Responsible for communicating with patients regarding scheduled appointments and/or tests. Uses appropriate method of communication based upon timing of appointments, as established in departmental protocol. (15%)
4. Responsible for following established tracking guidelines on pended requests for specialist, testing appointments and prior authorization results. (15%)
5. Documents all activity related to referral/test order in the EHR; documents the appointment date and time. Completes Transition of Care (TOC) activities, documents the transmission of TOC with every referral completed. (15%)

Note: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

MARGINAL JOB DUTIES

1. Provide reminder calls to patients of up-coming referral appointments.
2. Assist with data collection as designated by manager.
3. Perform other duties as assigned.

• You are expected to give priority to STAT orders, Urgent orders, daily testing, then normal orders for the assigned sites, in that order, on a daily basis
• Productivity expectations are:
• After 3 months experience, a minimum weekly output standard is 115 “counted referral output”.
• After 6 months experience, an average of 125 weekly output standard, or the equivalent, is expected to be accomplished and maintained for our staff within the department.
• You are expected to actively participate in a teamwork environment to accomplish the departmental goal of “yesterday’s referrals today”.
• You are expected to exhibit excellent customer service skills, on a daily basis, to all customers; patients, providers, co-workers, outside office staff, “everyone you encounter” in your work here at Great Lakes Bay Health Centers.

REQUIRED JOB SPECIFICATIONS

1. Education: High school diploma. Completion of a Medical Assistant program preferred. Registered MA or certification preferred. In lieu of medical training, five years or more experience considered. Education in a healthcare related field required.
2. Licensure: N/A
3. Experience: Minimum of three (3) years of experience in a medical setting
4. Skills: Excellent telephone etiquette. Clerical skills such as filing and completion of forms. Legible handwriting. Ability to operate office equipment including computer, fax machine, copy machine, etc. Able to follow through with assignments. in a timely manner. Must be able to use Microsoft Office and other applications as necessary. Ensures that patient. confidentiality is maintained at all times.
5. Interpersonal Skills: Able to communicate effectively with, and relate to, diverse population. Must be able to define problems, collect data, establish facts, draw conclusions to resolve issues/problems that occur during the referral process. Ability to follow oral and/or written instructions. Able to work independently and/or as a team member. Must exhibit excellent customer service skills daily.
6. Physical Effort: Must be able to sit, stand, and or walk for an entire workday. Must be able to lift, carry, push, pull, and or twist while holding up to 25 lbs. occasionally.
7. Hours of Work: Full-time; Flexible and varied.  Some evening or weekend hours may be required.
8. Travel: Generally, not a requirement of this position. Occasional travel between sites may be required. Travel for meetings and/or conferences, if scheduled. Reimbursement for usage of personal vehicle as outlined under GLBHC’s policy or usage of a company vehicle as appropriate.

GLBHC is an equal opportunity employer and prohibits discrimination and or harassment based on race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, and or local laws.