Job Details

This position is full-time, Days, Monday - Friday, 8 am - 5 pm and a Saturday rotation 8 am - noon

Summary

The Referral Specialist efficiently manages and processes patient referrals to ensure timely access to specialty care. This role serves as a key point of contact for patients, referring physicians, and specialists, providing comprehensive support throughout the referral process.

Key Responsibilities:

• Referral Processing and Documentation: Manage the full referral lifecycle, including obtaining necessary documentation, securing insurance authorizations, and accurately documenting all actions in accordance with departmental and Medical Home standards.
• Prioritization and Timeliness: Prioritize referrals based on urgency and departmental guidelines, ensuring timely processing and adherence to established timelines.
• Communication and Coordination: Serve as the primary point of contact, effectively communicating referral status, progress, and appointment details to patients and referring physicians. Coordinate appointments with specialist clinics and ensure patients receive comprehensive information regarding their referrals and scheduled appointments.
• Referral Tracking and Follow-Up: Monitor and track the status of all referrals, verify appointment completion, and ensure timely receipt of consultation notes. Facilitate the closure of the referral loop by forwarding completed notes to referring physicians.
• Information Management: Obtain and distribute relevant information such as downloading and forwarding PHIL sheets (patient calls to our after-hours services) the patient’s primary care provider.
• Reporting and Updates: Provide regular updates to physicians and management on open and pending referrals, outstanding consultation notes, and specialty wait times.
• Patient and Specialist Support: Address patient and specialist inquiries, resolve concerns, and provide exceptional customer service.
• Cross-Functional Support: Provide call center and front desk support as needed.

Education

High School graduate or equivalent.

Experience

Three years of healthcare administrative experience

1 or more years of healthcare referral process and insurance processes

Must have knowledge of various insurance company processes, diagnosis coding and any other duties required to provide quality care to our patients

Must have excellent customer service skills and enjoy working with the public

Ability to respond to patient family needs with compassion and understanding