Referral Specialist

Description

Under the direct supervision of the Health Records and Referrals Manager, oversees the Salud wide specialty referral program services at all Salud sites including: meeting, educating, and follow-up for referral services. Communicates with patients, families, staff, volunteers and physicians in a manner that focuses on the principles of quality client service. Responsible for the timely process, entry and accuracy and follow-up of referrals in the patients Electronic Health Records.                      

DUTIES AND RESPONSIBILITIES:

1. Follow Medical Provider order as noted and follow through in a timely, effective manner.
2. Coordinate and process the STAT/URGENT referrals to be completed within 24 hours for patients with critical health care needs.
3. Coordinate and process the Routine Referrals in 5 business days.
4. Monitor and follow up on EHR referral queue and ensure timely closing of open orders in a 30, 60, 90 days review system.
5. Notify patients of their appointments and location and assist with scheduling interpretation and transportation services; provide follow-up instructions as needed.
6. Verify eligibility by obtaining a RAF, TAR or other documentation.
7. Ensure complete and accurate registration, including patient demographic and current insurance information.
8.  Assemble information concerning patient’s clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
9. Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. This tracking may be used in the EHR system by using Task and notes in appropriate fields.
10. Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis and prognosis. Assist with financial information for charity or uninsured programs. Review details and expectations about the referral with patients.
11. Respond to patient’s inquiries in a timely manner in relation to their referrals.
12. Train staff as needed on new referral systems.
13. Insurance Liaison – Verify eligibility, pending authorizations and follow up as needed; identifies additional sources of assistance for uninsured and/or underinsured families.
14. Organize pediatric and adult referral scheduling and prepare paperwork/records in anticipation of provider needs.
15. Liaison between patients, providers, outside clinics, and hospitals regarding scheduling and follow-up for emergent and short-term cases. 
16. Communicate information via computer, phone, fax, and in writing to appropriate resources.
17. Reprioritize work on a continuous basis accommodating changes.
18. Establish, update, and maintain a computer based tracking system for all referrals.
19. Use computer to enter data or to retrieve information as required. Generate reports as needed.

20. If time allows, assist with assignments and cover for other staff members in their absence.

21. Maintain an effective working relationship with staff, managers, providers and the community.

22. Perform other referrals department duties as assigned.

23. Able to work in a fast-paced environment with individuals of diverse cultural background.  

24. Conduct all activities in a polite, courteous and professional manner and abides by company policies and procedures.

EMPLOYMENT STANDARDS:

Knowledge of: Must be able to interact and communicate effectively with patients and to maintain a pleasant demeanor when dealing with angry or frustrated callers, have excellent communication skills, customer service and telephone skills; strong organizational skills and ability to multi-task effectively, detail oriented and able to work efficiently in a stressful environment, a strong sense of teamwork.

Ability to: Understand and carry out oral and written directions, respect and maintain patient confidentiality at all times, follow policies and procedures, work a flexible schedule, and work between different locations, relate with all levels of individuals within the organization, perform daily procedures, meeting high quality standards, use his/her independent judgment following compliance standards and regulations.

Requirements

MINIMUM REQUIREMENTS:

• High school graduate
• At least 2 years of general experience in a healthcare environment; OR at least 1 year of general experience in a healthcare environment with 1 year of Referrals processing experience preferred. 
• Bi-lingual English/Spanish required.
• Basic computer knowledge required (MS Word, Excel and Outlook) and electronic health records.

Preferred qualifications:

• Completed/Passed Medical Terminology Course.
• Knowledge of ICD-10 desired.
• Excellent oral and written communication skills 

** Individuals hired on or after March, 2018, who have not successfully taken a Medical Terminology class (to be confirmed by proof of taking and passing class with a grade of “C” or better) will be placed at the Referrals Specialist scale that was in effect prior to March, 2018. They will have nine (9) months to successfully complete the class with a grade of “C” or better and they can use the Education Career Development money to pay for the class.**

PHYSICAL DEMANDS:

• Standing, walking, sitting, typing, reaching, bending; may move or lift up to 25 pounds.

SALARY & BENEFITS:

Salary: 

Benefits: available to all regular Salud employees working 24+ hours per week. Part-time employees may receive some benefits on a pro-rated basis.

• Medical, Dental, Vision, and Life Insurance Plans
• Paid Time Off (PTO): 19 days per year
• Paid Holidays: 12 per year
• 401(k) Retirement Plan with employer contribution
• Voluntary Long-Term Disability

Additional Information:

• Employees on temporary assignments are eligible for holiday pay and California sick pay, both pro-rated based on hours worked.
• On-call employees are eligible for California sick pay, pro-rated based on hours worked.

Salud is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Salud is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, contact the Salud Human Resources Department, [831-728-8250, and [email protected]].