SUMMARY
Under the direct supervision of the Clinical Director, and in adherence to the principles of a Patient Centered Medical Home, the Referral Specialist plays a crucial role in ensuring patients receive timely and appropriate specialty care. The Referrals Specialist ensures that the referral process initiated by the Provider is executed promptly and seamlessly and that there is continuous communication across the healthcare team to deliver coordinated, patient-centered care.
ESSENTIAL JOB DUTIES include the following:
Processes referrals from primary care providers (PCPs) to specialists or other healthcare services, ensuring they align with the patient’s care plan.
Monitors the status of referrals, follows up to ensure that patients attend appointments, and specialist feedback is returned to the primary care team.
Communicates with external providers, ensuring that the necessary information is shared (e.g., medical records, test results) to support the referral process.
Documents referrals and their outcomes in the patient’s medical records.
Ensure that all referrals are processed and completed in a timely manner, aligning with the urgency of patient needs, by consulting with the provider, and adhering to healthcare regulations and timelines.
Contacts patients to remind them about scheduled appointments and assists in rescheduling if necessary. Ensures patients understand the reason for the referral and are supported in accessing services.
Facilitates communication between the primary care team and specialists.
Checks the patient's insurance to verify that the referral is covered and coordinates with insurance companies to obtain prior authorizations for specialized services. If insurance or authorization problems arise, the Referrals Specialist communicates with the patient and insurance companies to resolve barriers.
May assist in collecting data on referral patterns, appointment adherence, and outcomes, which helps in evaluating the effectiveness of the referral process and identifying areas for improvement.
Supports Care Managers by working closely with them to ensure that the referral process aligns with the patient’s personalized care plan.
Respond to in-person, electronic, and telephone requests from providers, patients, and clinical staff.
All other duties assigned.
EXPECTATION OF EMPLOYEE
Regular and prompt attendance at work.
Understands the principles of a Patient Centered Medical Home.
Maintains a courteous, helpful and conscientious attitude in dealing with co-workers and patients and their families ensuring professionalism and confidentiality at all times.
Demonstrates flexibility, efficient time management, and ability to prioritize workload.
Meets productivity standards.
Highly organized with a strong attention to detail.
Demonstrates the ability to remain professional while handling a variety of attitudes and personalities from patients and staff.
Demonstrates the ability to handle multiple interruptions and regain focus.
Demonstrates effective verbal and written communication skills, and efficient use of computer programs and electronic health records.
Demonstrates the ability to work as an effective part of a team.
Performs duties as workload necessitates.
Possesses problem solving ability.
Demonstrates flexibility with change.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION/ CERTIFICATES, LICENSES, AND/OR EXPERIENCE
·High school diploma or GED (Required).
·Computer and Medical Terminology (minimum 1 year required).
Medical Assistant or CNA preferred.
·Experience working in a clinic or another medical facility (minimum 6 months required).
