Referrals Specialist

Job Title: Referrals Specialist

Position Function SUMMARY

Under the general direction of the Health Services Manager and Referrals Supervisor, the Referrals Specialist has general responsibility for maintaining electronic patient files, responding to and fulfilling requests for medical records and assisting in the collection of data. Additionally, they are responsible for managing external patient referrals and follow-up in collaboration with the provider and other members of the patient care team as well as assisting with coordinating travel for patients to and from appointments.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This position may have various work assignments within HICHC. This description is intended to be generic in nature, and as such it does not detail all duties and responsibilities of the particular job assignment. Various duties, responsibilities and accountabilities may be assigned to an incumbent in this position depending on the specific job assignment, and may include but not be limited to the following:

• Prioritizes patient referrals to correlate with managing patient flow for maximum efficiency and optimum care provision.
• Demonstrates appropriate utilization of medical records to document care within scope of job duties.
• Coordinates referrals, preauthorization, and follow-up with appropriate external resources.
• Develops and maintains tracking system for referrals to outside resources.
• Actively participates in quality improvement and risk management programs.
• Participates as an active team member on the patient care team.
• Participates in continuing education activities.
• Demonstrates competency in managed care preauthorization for travel.
• Documents appropriately in the patient medical record.
• Facilitates process for quality specialty medical, diagnostic and therapeutic services to be available to patients via appropriate referral and tracking for follow-up.

• Demonstrates positive interpersonal relations in dealing with physicians, patients, patient families, visitors, co-workers, in a professional and confidential manner.
• Embraces the philosophy of continuous quality improvement.
• Maintains a safe, clean, and confidential working environment consistent with OSHA, HIPAA, and HHC standards.
• Communicates accurate and pertinent information with patient care providers and other members of the care delivery team to facilitate effective and efficient patient referrals and tracking.
• Applies age-specific/cultural considerations to referral process.
• Manages changes in work demand during work-day.
• Ensures patient/family satisfaction with referral services.

• Keeps supervisor informed of problems or issues; monitors supplies needed; performs other duties as assigned.

This individual must be able to effectively communicate both in written and oral form. This person must be capable of prioritizing and organizing tasks related to patient care. The referrals specialist is expected to support the Health Center's mission and adhere to Health Center policies and procedures, as well as applicable state and federal regulations. He/she is expected to demonstrate superior organization, ability to multi-task, have effective interpersonal skills and be an active part of the patient care team

POSITION SPECIFICATIONS

Requirements of Position

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

Education and Experience

• High School graduate or GED certificate.
• One year of related clinical office experience and/or training is required; OR any equivalent combination of experience, training and/or education.
• Desirable experience includes:

• Familiarity with QUEST and other insurance programs
• Familiarity with Hawaiʻi Health Care Networks
• Knowledge of ICD-10 and CPT coding

Knowledge, Skills and Abilities

This position requires a basic knowledge of general office procedures to include filing, copying, and faxing.

• Ability to use a computer to enter patient data and retrieve information.
• Ability to work on multiple tasks within established deadlines.
• Ability to work under the direction of a supervisor and follow instructions.
• Ability to take the initiative to resolve patient concerns and problems.
• Knowledge of patient chart documentation.
• Ability to communicate effectively in written and oral form with a diverse population.
• Demonstrate above average organizational capabilities.
• Demonstrate above average teamwork capabilities.
• Ability to multitask in a supportive patient care role to a diverse population.

Language Skills

• Ability to read and interpret documents such as government regulations and guidelines, patient records, operating and maintenance instructions, procedure manuals, etc.
• Ability to write at a minimal level of competence, including internal reports and memoranda.
• Ability to communicate with diverse groups of people to include staff and providers and patients.
• Ability to communicate effectively with patients and their families to make their visit a pleasant experience.
• Sensitivity to the multicultural nature of the service area population and may be required to assist patients using interpreter services.

Personal characteristics

Personal characteristics include: a team player, high integrity, communication and customer relations skills, regular work attendance, courteous and friendly, able to work well with diverse groups of people, gain and maintain respect of others, accept HICHC mission and values.

Confidential and Sensitive Information

Because the employee has access to personal and professional data regarding individual employees and their families, personal data regarding individual patients and the families, and/or sensitive company financial data, an essential job result is the maintenance of a high level of confidentiality of the information processed by the employee. Violation of this confidence may result in disciplinary action, up to and including termination of employment.