Referral Specialist

Job Summary

Under the direction of the Population Health Manager, the Referral Specialist works as part of a patient care team to provide high quality, efficient and service oriented patient care while demonstrating the health center’s core values.

Essential Values-Based Competencies

• Dignity: Demonstrates competence in communication and interpersonal relations
• Excellence: Demonstrates competence in continuous improvement, continuous learning, and teamwork/collaboration
• Service: Demonstrates competence in customer/patient focus, adaptability, and shaping change
• Justice: Demonstrates competence in community orientation, stewardship, and strategic planning and action

Essential Functions

• Work diligently, cooperatively, and effectively with patients, medical providers, health center staff and community stakeholders in all aspects of patient care and care coordination.
• Provide positive, supportive and caring behavior in all communications to patients, community stakeholders and staff.
• Maintain patient confidentiality and HIPAA practices at all times.
• Obtains and processes referrals from providers and communicates authorizations with patients (via phone & mail) and medical staff in a timely manner.
• Prepares, processes, and completes referrals accurately and in a timely manner, including urgent and stat referrals for assigned members.
• Tracks referrals in the electronic medical records (EMR) system; Follows up on submitted authorization requests and maintains consistent status updates via EMR.
• Makes sure to monitor and report on statuses of authorization requests; escalates issues as necessary until fully resolved and referral loop is closed.
• Communicates referral and authorization information and pertinent medical information to the patient and specialty providers.
• Manages the need for redirection across all clients and payers by working with clinical teams to ensure timeliness of re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care.
• Reviews consultation reports for needed follow up requests and works with providers to ensure timely processing of all follow ups.
• Works with the health information (medical records) department to ensure timely retrieval of consultation reports.
• Aids patients with scheduling appointments with the specialist should the patient express any challenges in accomplishing this themselves.
• Sets up retro-authorizations and distinguishes between primary care and internal specialty visits.
• Participates in daily morning care team huddles and scheduled department meetings.
• Screens and answers related referral calls by telephone, patient portal, patient walk-in and/or by mail.
• Serves as the main point of contact for providers and clinic staff regarding referrals, authorizations, and appointment scheduling.
• Serves as an advocate and discusses with participants all aspects of the referral process as needed or requested by the treating provider.
• Arranges transportation for participants to medical appointments at Camino Health Center and other organizations.
• Documents all actions taken in the participant medical record in accordance with current Clinic, DHCS and CMS regulations/guidelines.
• Acts as a liaison between participant, clinic/providers, specialty care providers, hospitals, and other community resources.

Additional Responsibilities

• Performs other duties as assigned by supervisor

Knowledge / Skills / Abilities

• Work collaboratively with people of all ages, social, and ethnic backgrounds
• Ability to work in a fast paced environment
• Basic/Excellent oral and written communication; basic math skills
• Ability to convey a sense of confidence and trust to all patients
• Ability to relate well to other health professionals and support staff
• Ability to carry out administrative and patient support services
• Ability to maintain patient confidentiality
• Knowledgeable about and experience with current procedural terms (CPT), international classification of diseases (ICD-10), and medical terminology
• Excellent planning and organizational ability

Age-Related Competencies

• Knowledge of, observes, and complies with clinic safety policies and emergency procedures

Information Management

• Treats all information and data within the scope of the position with appropriate confidentiality and security

Risk Management

• Cooperates fully in all risk management activities and investigations

Physical and Personal requirements

• Able to work flexible hours, including evenings and weekends
• Able to work at various health center locations and outreach sites
• Able to lift/carry 10 lbs./weight
• Able to stand for long periods of time

Environmental Conditions

• The job operates in a professional office environment.
• This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
• Position involves sitting for extended periods of time while working at a computer.
• Positions in this job family typically work in an office setting but may be assigned more physical duties such as transporting office supplies and equipment.