The Referral Specialist is responsible for scheduling or coordinating all internal and external referral appointments and acquiring referral authorization. They will process and route incoming and outgoing correspondence and telephone calls for providers and communicate with patients when needed.
- Schedules referral appointments for the patients at the referral specialties/facilities. Whenever possible, appointments are made with patient present.
- Provides patient referral information to the referred facility in accordance with the patient’s insurance plan.
- Serves as a Liaison between FHLC, referral facility/specialty and the patient. Consults with other clinical staff as needed.
- Gives complete, accurate, and adequate information to the referred facility and to the patients, including written and oral.
- Maintains a tracking system of all external and internal referrals.
- Follow up with specialist/diagnostic services to confirm patient kept appointment and record in medical record.
- Demonstrates knowledge of preps required for diagnostic testing.
- Is aware of hospital and specialty office policies and utilizes current list of approved specialists to use if PCP doesn’t specify.
- Is knowledgeable of where specialized tests are provided and if not certain, seeks correct information in a timely manner.
- Completes necessary forms, calls and prior authorization requirements associated with both public and private insurance carriers
- Gathers all required forms, office visit data and reports necessary for the referral to be processed.
- Documents referral information in the EHR identifying specialist name, NPI, location, telephone, appointment date/time, and prior authorizations (if applicable).
- Contacts referral site and makes an appointment whenever possible,
- Documenting appointment date in the EHR.
- Sends letter to patient with date and instructions needed for the appointment and directions as to what to do if appointment cannot be kept.
- Accepts, opens, documents, and appropriately manages mail related to referral appointments kept.
- Ensures proper use of all office equipment (fax, copier, PC, e-mail, software, printers, phones, voicemail, etc.) in accordance with FHLC policy. Maintains proper supplies for its use. Immediately reports any malfunction to Supervisor and/or IT.
- Is expected to recognize barriers to specialty care, informing the appropriate supervisor and provider immediately when such circumstances occur.
- Attends meetings and seminars to keep abreast of changing needs within the industry and department.
- Attends Quality Improvement, Quality Operations meetings and other meetings as required or as assigned by Supervisor.
- May need to participate in required trainings, including webinars and possible off-site trainings.
- Knowledge of QA/QI processes, participates in QA/QI meetings as needed.
- Promotes working relationships with other departments.Respect and maintain patient confidentiality in all aspects of care including use of electronic information.
- Treat all patients in a welcoming and professional manner.
- Demonstrate professionalism by appropriate attire, attendance, attitude, and behavior within the clinical setting.
- Contribute to the team effort by supporting all team members and maintaining an open and positive attitude.
- Welcome new employees to the team by assisting with their orientation to the team and mentoring them, as requested.
- As needed assists with the scheduling of patient appointments, based on established guidelines.
- Answer phones, take accurate complete messages, particularly related to patient issues.
- Any patient issues received via telephone, voicemail, letters, or walk-ins will be communicated to providers and/or nurses by using Telephone template or in-basket messaging feature.
- Support the teams with data collection, entry, and communications.
- Must adhere to FHLC policies and procedures.
- Regular and Reliable Attendance.
- Other duties as assigned.
Family Health La Clinica is proud to be an Equal Opportunity-Affirmative Action employer.
- Will have strong organizational skills with demonstrated proficiency in computer applications (Microsoft Office).
- High attention to detail is required.
- Excellent communication skills (written and oral) professional demeanor, good problem-solving skills, organized and detail oriented.
- Must be detail oriented, self-motivated and assertive.
- Proven experience working with a culturally diverse population.
- Ability to work under pressure, with potentially difficult people, maintaining strict confidentiality.
- This fast-paced position requires a high level of independence, and flexibility.
- Understanding of Medicare, Medicaid and managed health care plans is necessary for this position.
- High School diploma or equivalent required.
- Six months to one year related experience and/or training preferred; or equivalent combination of education & experience.
Family Health La Clinica(FHLC) requires employees to be vaccinated against COVID-19, or hold a legally recognized exemption as a condition of employment. Where permitted by law, candidates who are offered a position will be asked about their vaccination status, which must meet minimum business requirements. All religious, medical, or other legally recognized exemptions regarding vaccination status will be considered.