Referral Specialist/CHW

Job Summary

The Referral Specialist/CHW will be the embodiment of the hospital’s mission, vision and values. They will greet patients, families and hospital guests upon arrival and assist them in navigating through all aspects of their hospital visit. The position is responsible for coordinating any additional care the patient may need inside and outside of our facility. The position is responsible for obtaining prior authorization needed for testing or services.

Essential Job Responsibilities

• Promote the mission, vision, and values of the organization
• Greet all patients, families and hospital visitors with a positive, cheerful attitude
• Notifies the client of appointments scheduled, makes follow-up calls to off-site providers to ensure that client kept appointment and reminds provider to submit a Consultation Report
• Maintains competency in obtaining and inputting medical information to and from clinical and /or other information systems including accessing information as required to complete the referral process
• Screen and schedule incoming referrals
• Obtain prior authorization for diagnostic services and procedures
• Work with Clinician to assess and address patient’s needs
• Assist patients in obtaining medications through prescription assistant programs and other means
• Collect data and write brief reports to meet evaluation needs to the ECHO program
• Obtain prior authorization for specialty medications, and coordinate with specialty pharmacy
• Answers questions from patients, clerical staff, and insurance companies
• Establish and maintain relationships with identified server providers
• Utilizes software to code ICD- and CPT codes
• Contact customers to obtain or relay account information
• Provides back up support to medical records and front desk registration
• Be knowledgeable on all of RGH services
• Serve as the main communications person for the department, answering and placing phone calls, taking and relaying messages for clinical staff

Non-Essential Functions

• Performs other duties as assigned.

Roosevelt General Hospital (RGH) is committed to providing safe, quality care to patients. Employees are required to adhere to the Values of RGH.

Qualifications

• High school graduate or equivalent
• Ability to communicate effectively
• Knowledge of medical procedures and medical terminology
• Basic to intermediate computer knowledge
• One year of medical office experience required
• Typing speed: minimum 40 wpm, computer knowledge
• Spanish speaking is preferred
• Previous customer service experience preferred
• Knowledge of CPT / ICD- coding helpful.

Professional Requirements

• Adhere to dress code, appearance is neat and clean.
• Complete annual education requirements.
• Maintain patient confidentiality at all times.
• Report to work on time and as scheduled.
• Wear identification while on duty.
• Maintain regulatory requirements, including all state, federal and local regulations.
• Represent the organization in a positive and professional manner at all times.
• Comply with all organizational policies and standards regarding ethical business practices.
• Communicate the mission, ethics and goals of the organization.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings and in-services.

Knowledge, Skills, and Abilities

• Knowledge of medical insurances (Medicare, HMO’s, PPO’s, commercial), EMTALA regulations, hospital billing and collection process
• Must have an enthusiastic and positive attitude
• Possess a genuine desire to help RGH become an exemplary hospital in the surrounding community and the state
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
• Ability to manage multiple and simultaneous responsibilities and to prioritize duties/tasks
• Ability to initiate communication with patients, their families and hospital visitors
• Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families
• Must have a professional demeanor and excellent public relations skills
• Willingness to develop or improve public speaking skills
• Must have excellent written skills with knowledge of medical terminology
• Must be dependable and on time
• Possess good 'people skills' for building relationships with colleagues at all levels
• Ability to plan and prioritize workload to meet deadlines

Physical Requirements and Environmental Conditions

• Work is performed during regular work hours, but may require overtime and/or weekend hours to meet deadlines
• Work in varying degrees of temperature (heated or air conditioned)
• Work under extreme pressures
• Position requires sitting for approximately 4-8 hours per day and walking for 2 hours per day
• Position requires light to moderate work with 50 pounds maximum weight to lift and carry
• Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing