Referral Processing Specialist

Responsibilities

• Collects and records medical, social, and reimbursement data pertinent to patient admission to initiate home care, palliative care, and hospice.
• Screens, documents, and processes requests for home health, palliative, and hospice services, including:
  • Taking incoming calls and answering customer questions.
  • Completing intake forms and processing referral orders within EPIC or faxed referrals.
  • Documenting service requests for coordination of care, including promoting company products and services.
• Collaborates with the nursing team when reviewing and processing physician orders for instructions on a patient's plan of care. Ensures activities are performed within the scope of practice before sending patients to the appropriate service department.
• Communicates and documents any new, changed, updated information, orders, or referrals received within intake to the appropriate persons and/or departments to maintain the quality of care and safety of patients.
• Responds to inquiries regarding services and programs, explains them, and determines if patients meet criteria for CMS-certified agency admission policies. Refers requests to other community agencies when appropriate.
• Maintains knowledge of and reference materials for Medicare, Medicaid, and third-party payer requirements, coverage guidelines, documentation requirements, and insurance-related changes or trends.

Requirements

• High School Graduate (Required).
• Typically requires 1 year of experience in a clinical environment.

Skills

• Basic medical knowledge.
• Strong verbal and written communication skills, including experience in data entry, multi-line phone systems, and customer service.
• Excellent interpersonal skills necessary to interact with internal and external customers.
• Demonstrated ability to work well with physicians and other professionals.
• Proficient computer skills, including word processing and electronic mail.
• Detail-oriented with excellent organizational skills.

Physical Requirements and Working Conditions

• Generally exposed to a normal office environment.
• Must be able to sit for extended periods and may be required to stand, bend, twist, kneel, squat, and reach above the shoulders throughout the workday.
• May be exposed to hazardous chemicals, loud noises, or hazardous equipment when patient care is involved.
• Position requires travel for education and periodic off-site meetings. May be exposed to road and weather hazards.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities. The incumbent may be required to perform other related duties.