Job Description
The centralized Referral Specialist processes referrals, receiving all in-coming correspondence, telephone calls and faxes related to the referral process; processes all referral requests using the Standard Operating Procedure developed by the Referral Department; participates in a team-based approach to care in the Patient Centered Medical Home (PCMH); participates in activities related to Quality Improvement.
Job Duties
- Answers incoming departmental calls, ensuring that all calls are handled or routed as appropriate.
- Processes the insurance company authorization per the preferred method (electronic, fax, telephone) for any referral requiring prior authorization. Notifies specialist office or testing facility of prior auth approval/auth number if required. Ensures that all authorizations are communicated to entities applicable in the process, and that relevant documentation is shared according to established practices within GLBHC guidelines.
- Responsible for communicating with patients regarding scheduled appointments and/or tests. Uses appropriate method of communication based upon timing of appointments, as established in departmental protocol.
- Responsible for following established tracking guidelines on pended requests for specialist, testing appointments and prior authorization results.
- Documents all activity related to referral/test order in the EHR; documents the appointment date and time. Completes Transition of Care (TOC) activities, documents the transmission of TOC with every referral completed.
Requirements
1. Completion of a Medical Assistant program required. Registered or Certified Medical Assistant preferred. LPN or RN students considered. In lieu of MA training, five or more years’ experience in a similar healthcare position will be considered.
2. Minimum of three years-experience in a medical setting.
3. Excellent communication and computer skills desired.
4. One year of service in current position to be eligible for transfer
