Referral Specialist

About the role

The Referral Coordinator reports to the Prior Authorization Supervisor. Under general supervision, coordinates the effective and efficient patient flow regarding pre-registration scheduling appointments with specialists and testing per physician request. Obtains proper insurance authorization prior to scheduling appointment and, once completed, contacts the patient with pertinent information and ensures that all required information is forwarded to the specialist office following practice protocols. Follows the patient’s status within the cycle of provider care to ensure continuity of services utilizing LifeChart referral workques. Functions as a liaison between the hospital and patients to facilitate the solution of patient financial issues concerning outpatient registration. Coordinates the effective and efficient processing and scheduling of all incoming referrals, adhering to established timelines and departmental procedures.

Responsibilities

• Preregister/schedule/coordinate/triage all referrals created by and sent to the practice via LifeChart workques.
• Sets follow-up alarms per practice protocols and the tracking function to ensure that all outstanding referrals are followed up on.
• Monitor/update pre and post registration workqueues.
• Obtains all un‑resulted consults and testing orders managed by the referral office.
• Alerts the ordering provider of any patient that does not keep an appointment with a specialist or testing facility.
• Receives and reviews all incoming referrals ensuring completeness and accuracy.
• Ensures all information is received including patient demographics, insurance and authorizations.
• Communicates promptly with referring provider and/or patient regarding insurance coverage issues (e.g., non‑participation status) so the patient may seek timely services elsewhere.
• Maintains current knowledge of insurer referral authorization requirements and has a working understanding of the patient population, demonstrating cultural awareness and sensitivity.
• Documents any communication with referring providers, patients and/or clinic staff (MD, RN, etc.) in the EHR.
• Collaborates with social work, Patient Financial Advocate and Patient Navigator for financial assistance and eligibility.
• Participates in practice performance and quality improvement activities.
• Attends required meetings and trainings as directed.
• Performs other related duties as assigned.
• Consistently monitors clinic schedules to ensure maximized scheduling and fills any available/open timeslot, including appointments cancelled and/or rescheduled.
• Notifies provider and/or supervisor if unable to schedule a referral or if there are access issues.
• Monitors referral work‑queues and ensures that all referrals have been processed accordingly.

Requirements

• High school degree or equivalent.
• Billing and medical knowledge preferred.
• Two years of clinical referral experience preferred.
• Data entry skills and computer experience required.
• Strong customer service focus.
• Effective verbal and written communication skills.
• Organized and able to manage competing priorities.
• Able to take and follow through with delegated tasks and accountability.
• Demonstrated knowledge and skills necessary to provide care to patients throughout the life span, with consideration of aging processes, human development stages, and cultural patterns in each step of the care process.
• Performs independently within department policies and practices.
• Refers specific complex problems to the physician practice manager where clarification of departmental policies and procedures may be required.

Pay

Pay Range $18.00‑$25.82

Schedule

Work Type: M‑F; Work Shift: Day; Daily Hours: 4 hours; Driving Required: No

Location: East Providence‑375 Wampanoag Trail, East Providence, RI 02915