Referral Specialist Community Health

Job Summary:

The Referral Specialist will work with other primary care team members to support high-quality, well-coordinated, highly organized, patient-centered care for patients and their families/caregivers/support systems. The Referral Specialist will work in several capacities to support the assigned primary care teams.

Essential Support Functions:

Duties and responsibilities of the Referral Specialist may include but not be limited to -

1. Referral Management - Review referral orders and ensure all necessary documentation is included to facilitate transmission of orders with minimal delay. Manage closed loop referrals from outbound order processing to the receipt of inbound documentation to reflect care was provided. Prioritizes meeting with patients at their visits to provide all information needed to schedule referrals.
2. Order Tracking & Follow Up - Perform order tracking and follow up for specialty referrals, imaging (and other) orders to ensure timely completion and assist with any identified barriers to care.
3. Prior Authorizations - Communicate with payers/health plans and external agencies to provide necessary information and utilization review data to facilitate timely prior authorization processes and documentation.
4. Patient Scheduling & Reminders – Work to educate patients to enable them to independently schedule referrals. Assist with patient scheduling processes and communication with patients to provide the information needed to promote continuity of care across the continuum.
5. Patient Communication & Engagement – Interact with patients in an effort to understand and address patient needs and preferences in a culturally competent manner. Assist in identifying SDOH risk factors and aid in connecting patients to appropriate internal services and resources.
6. Care Gap Closure – Promote closure of Care Gaps through targeted communication campaigns. Utilize patient engagement strategies and appropriate communication portals to help route patients to the appropriate member of their primary care team.

Care Team Support - Collaborate with members of care team(s) and maintain timely, accurate, and appropriate HIPAA-compliant documentation in EJR (and other HIT/internal communication systems) per established protocols and best practices. Participate in team huddles and meetings as appropriate.

7. Maintains accurate scheduling resource information. Reaches out to specialists to confirm that contact information and patient requirements are current for both insured and uninsured patients.
8. Establishes and maintains effective, professional working relationships with all internal and external customers, including other healthcare offices and facilities.
9. Required to work on-site and travel to all SHHC locations as needed and as directed by management.
10. Other duties as assigned.

Operational Excellence

• Possess a professional, positive, team-oriented attitude.
• Provide a positive patient-centered experience for every patient.
• Consider safety of patients a priority and works to support a safe patient experience.
• Adhere to professional scope of duties and responsibilities. Refrains from providing any clinical advice and/or making clinical judgements. Escalates to appropriate clinical team members in a timely manner.
• Maintain a current, up-to-date knowledge of Squirrel Hill Health Center’s policies and procedures.
• Create and maintain an efficient, highly productive work environment.

Relationship Management

• The Referral Specialist will work to educate identified patients to encourage them to independently schedule referrals. They will work collaboratively with practice providers, clinical staff and ancillary care teams, patients, and families/caregivers to establish healthcare and lifestyle goals and maintain open lines of communication across the care team.
• Engages others and models positive behaviors of team-based care philosophy.

Qualifications / Position Requirements

• Preferred
  • Previous healthcare experience
  • Previous experience working with electronic scheduling systems.
  • Previous experience with electronic medical record systems
  • Familiarity with basic medical terminology
  • Basic knowledge of healthcare insurance (related to benefits, authorizations, and referrals)
  • Basic knowledge of healthcare related data and reporting
  • Bilingual (Spanish/English)
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  • All CDC recommended immunizations, including updated COVID-19 vaccines.
  • Must be 18 years or older.
  • High School Diploma or equivalent.
  • Ability to perform routine assignments independently.
  • Demonstrates attention to detail and organizational skills.
  • Excellent communication skills – verbal & written.