Access Referral Specialist

We are seeking an Access Referral Specialist to join our Access Center team. This role serves as the primary point of contact for inbound calls, faxes, and emails from referral partners, the community, and Gilchrist staff, ensuring high-quality customer service in referral development and management. The specialist supports exceptional customer service and coordinates referral development and patient access across all Gilchrist service lines, including hospice, palliative care, and geriatric medical services.

About the role

The Access Referral Specialist works under the supervision of the Access Center Manager to deliver professional, compassionate services aligned with Gilchrist’s mission and core values. This role is responsible for establishing and maintaining relationships with patients, families, and referral sources, addressing customer requests and concerns, and ensuring accurate documentation. The specialist facilitates the admission and appointment scheduling process for hospice patients and collaborates with organizational disciplines to support admissions for hospice, palliative, and geriatric medical services.

Responsibilities

• Verify insurance coverage for patients with Medicare/Medicaid and identify applicable commercial insurance plans; coordinate with the clinical team for concurrent care review as needed.
• Utilize DocuSign to obtain signatures for patient consents and other required documentation.
• Assist field staff with uploading documents to the EMR and obtaining consent signatures.
• Monitor admission appointments for all Gilchrist entities for completeness, geographic efficiency, and nurse schedules.
• Assist the Access Center Manager with revising workflows, Epic reporting, and Epic Dashboard/Workqueue management.
• Participate in mentoring and leadership development classes to enhance leadership skills.
• Manage data and maintain proficiency in Windows, Excel, Word, and all Gilchrist programs.
• Serve as the primary point of contact for referral sources, ensuring knowledge of all Gilchrist programs and services to assist callers in enrolling in the best program for their needs.
• Schedule visits for all inquiry and referral callers across Gilchrist programs and services.
• Accurately record referral information for business tracking and management.
• Follow policies and procedures for admissions management and schedule admission visits within required timeframes.
• Conduct thorough follow-through for internal and external customers, achieving targets for customer service metrics.
• Maintain an accurate pending referral list and communication log.
• Dispatch visits to Gilchrist providers, Access RNs, and Hospital Liaisons, coordinating visit schedules for pre-admission staff.
• Ensure timely follow-up on all pending patients and non-admits.
• Facilitate processing of admission documents from referral call through transfer to the appropriate care team.
• Document all call information according to standard operating procedures within the Epic record.
• Communicate prospective patient updates to referral sources and internal stakeholders for unit placement.
• Coordinate with referral sources, DME, pharmacy, and other vendors to process certifications, orders, and required admission information.
• Schedule patient services such as ambulances and home medical equipment for safe admissions.
• Train in bed management and fill in as needed in this role.
• Mentor and train new team members in all aspects of the work, providing feedback and coaching.
• Enter prospective and admitted patient demographic information and status updates in the Epic database.
• Complete all documentation, forms, and logs for referral calls and admissions processing, ensuring data accuracy in Epic.
• Work Epic work queues as outlined in standard work documents.
• Resolve referral and admissions management issues through direct communication with referral sources and the admissions team; escalate unresolved issues to the Access Center Manager.
• Work on special projects to support area/process improvement.
• Reverify physician licensure as needed.
• Make follow-up calls for referral inquiries within required timeframes.
• Ensure compliance with all state, federal, and CHAP requirements.
• Generate and electronically file appropriate patient-related information for the medical record consistent with company policy and regulatory requirements.
• Run Daily Epic Admission and Referral Reports, monitor and maintain the Epic Pending Admission report.

Requirements

• High School diploma or equivalent; Associate’s or Bachelor’s degree preferred.
• Minimum of 3 years’ experience with Gilchrist or equivalent experience in a complex healthcare call center.
• Working knowledge of the healthcare environment and terminology preferred.

Skills

• Strong phone skills, including excellent verbal communication and active listening.
• Ability to manage conflict and resolve concerns from the community.
• Collaborative mindset with the ability to work well across departments.
• Knowledge and ability to verify insurance benefits for Medicare/Medicaid and commercial insurance payors.
• Prior experience with DocuSign or equivalent tools for obtaining patient consent signatures.
• Understanding of Conditions of Participation, CHAP, and other regulatory requirements for hospice, palliative, and geriatric services admissions.
• Ability to work effectively with nurses, physicians, nurse practitioners, social workers, and other healthcare professionals.
• Detail-oriented with a high degree of accuracy and reliability.
• Strong computer skills, including proficiency in Windows, Excel, and Word.
• Ability to multi-task, set priorities, and manage time effectively.
• Demonstrated empathy, genuine concern, and passion for helping customers.
• Strong assessment skills to identify customer needs, clarify information, research issues, and provide resources.
• Proficiency in Epic, including the ability to make recommendations for build-outs, run reports, analyze data, and implement process improvements.
• Ability to work on-site, including during emergency weather and other critical situations.

Pay

Pay Range: $21.91 - $37.08 per hour. Final salary offer will be based on the candidate's qualifications, education, experience, and alignment with organizational needs.