OPS - Referral Specialist

Job Description

Job Description

POSITION SUMMARY:
The Referral Specialist will be responsible for processing referrals for patients to seek medical treatment outside of CCI Health Services.

As a member of the health center’s integrated care team, the Referral Specialist will fulfill the following KEY FUNCTIONS AND RESPONSIBILITIES towards the provision of patient-centered, coordinated patient care:

• Prepares and processes all managed care referral paperwork.
• Schedules appointments for specialists when needed.
• Prepares pertinent information from referring providers to complete referrals.
• Contacts various offices/facilities to obtain the necessary information to accurately complete referral requests.
• Maintains referral records and files documentation.
• Process Infant and Toddlers and Child Find programs.
• Assist with check-out and follow-up appointments with PCP.
• Scan documents into the patient chart.
• Process Breast and Cervical Cancer Diagnosis and Treatment program referrals.
• Learn and process Catholic Charities/Project Access referrals.
• Process insurances referrals pre-authorization.
• Run and follow up with i2i reports.
• Maintains the strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Assists patients to fill out applications for specialty programs.
• Obtain pre-authorizations for specialist visits/imaging when necessary.

REQUIRED SKILLS OR ABILITIES:

• Requires experience and demonstrated abilities for working in a multi-cultural setting.
• Knowledge of some medical terminology.
• Ability to collaborate and interact with a diverse group of health care professionals.
• Ability to initiate and maintain a working relationship.
• Have understanding and knowledge of population and community of service area.
• Good community skills: able to listen well, use language appropriately, and able to communicate in writing.
• Excellent customer service skills.

REQUIRED KNOWLEDGE, EXPERIENCE, OR LICENSURE/REGISTRATION:

• Minimum High School diploma, an AA or BS degree preferred or commensurate experience
• Current CPR certification.
• Bilingual in Spanish and English preferred.

WORKING CONDITIONS:

• Proper and professional grooming is always expected
• Prolonged periods of standing, bending or working at a desk on a computer
• The ability to lift (up to 15lbs) is required.
• Work under stressful conditions within a controlled enclosed environment daily. The work environment involves exposure to potentially dangerous materials and situations that require extensive safety precautions and may include the use of protective equipment.
• ADA Category. In accordance with the American with Disabilities Act, it is possible that requirements may be modified to reasonably accommodate disabled individuals. However, no accommodation will be made which may pose serious health or safety risks to the employee or others or which impose undue hardships on the organization.
• OSHA Category 1. Clinical environment. Possibility of exposure to chemicals and infectious body fluids e.g., HPV, HIV, HEP C, HSV.

Equal Employment Opportunity (EEO)

CCI Health Services does not unlawfully discriminate based on race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer related or genetic characteristics or any genetic information), marital status, sex, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. All personnel decisions are to be administered in accordance with this policy and in compliance with applicable federal and state law, including, but not limited to, decisions regarding recruitment, selection, training, promotion, compensation, benefits, transfers, lay-offs, tuition assistance, and social and recreational programs.

The CEO & President of CCI and all managerial personnel are committed to this policy and its enforcement. Employees are directed to bring any violation of this policy to the immediate attention of their supervisor, Human Resources, or the CEO & President. Any employee who violates this policy or knowingly retaliates against an employee reporting or complaining of a violation of this policy, shall be subject to immediate corrective action, up to and including termination of employment. Complaints brought under this policy will be promptly investigated and handled with due regard for the privacy and respect of all involved.