Referral Specialist

Referral Specialist The Referral Specialist works under the direction of the Clinic Manager as part of a multidisciplinary team composed of physicians, nurse practitioners, physician assistants, and clinical support staff. The Referral Coordinator is a member of the OLE Health clinical care team and works in continuous partnership with the patient, their family when appropriate, OLE Health care team, and relevant community partners to improve health outcomes and meet the patient’s desired health and wellness goals by: Serving as the contact point, advocate, and informational resource for patients, family/caregiver(s), primary care team, payers, and community resources Facilitating access to internal and external services Identifying and addressing gaps in care Increasing patient’s ability for self-management and shared decision-making OLE Health provides an inclusive workplace that promotes and values diversity and life experience. OLE Health encourages people of all backgrounds to apply including, but not limited to, Black, Indigenous Peoples, people of color, immigrants, refugees, women, LGBTQIA+, people with disabilities, veterans, individuals of all ages and religions, and individuals who have been affected by the legal system. ***The following reflects requirements and essential functions of this position but does not restrict tasks that may be assigned. Essential functions include basic job duties, core elements, or fundamental responsibilities that an employee must perform to hold the position. Employees must be able to perform these essential functions with or without reasonable accommodation (accommodation may be requested). Duties and responsibilities are not all-inclusive, and they may be assigned or reassigned to this job at any time, due to reasonable accommodation or any other reason. *** MINIMUM POSITION REQUIREMENTS: EDUCATION, EXPERIENCE, SKILLS/TRAINING Education: High School Diploma or equivalent. Experience/Lived Experience: Experience working with diverse populations; displays respect and sensitivity to cultural diversity. Experience working in community health setting. MA training preferred. Special Skills/Training: Strong collaborative skills; ability to effectively and appropriately engage members of the care team, other clinic departments, leadership, and external community partners. Exceptional communication skills; ability to effectively engage patients and assess needs and concerns to ensure that the patient is referred appropriately. Excellent in-person and phone customer service skills; able to manage difficult and emotional patient situations and to respond promptly to patient needs. Ability to adapt to change; approach challenges with an innovative and proactive attitude; and investigate resources. Strong verbal and written communication skills required. Bilingual Spanish required ESSENTIAL FUNCTIONS AND RESPONSIBILITIES 1. Demonstrates exceptional customer service skills including greeting patients or colleagues in a kind, compassionate and courteous manner; responds effectively to patient or care team member questions; manages multiple priorities and heavy patient workloads with patience and confidence 2. Strong communication skills and ability to effectively present and share facts and ideas both orally and in writing. Keeps Referral Specialist lead, manager, or any other appropriate department leads informed of pertinent matters. 3. Following HIPAA guidelines will enforce patient privacy and confidentiality guidelines with all clients; ensures that all protected health information is out of view and is secure when work shift has ended; Ensures that all protected health information is disposed of in the proper manner when required. 4. Has a knowledge of insurance payors and state programs offered at OLE Health including but not limited to Partnership Health Plan, Medi-Cal, Medi-Care, Commercial Insurance, Sliding Fee Scale, or other programs available to the under/uninsured population in order to connect the patient with proper specialty service. 5. Supports and collaborates with the referring provider to process referrals to specialty care provider per department guidelines while ensuring a closed loop process is followed. 6. Acts as a community partner liaison facilitating the communication between external agencies and internal medical providers at OLE regarding referrals. 7. Documents all appropriate information while keeping the integrity of the electronic health record system ensuring to keep patient confidentiality. Including but not limited to telephone calls, letters, MyChart messages, and all other forms of approved patient and specialty communication methods. 8. Keeps team members as well as leadership abreast of any specialty provider access barriers or requirements to ensure patients can connect to specialty care in a prompt manner. 9. Processes prior authorization to specialty office as indicated by insurance network. 10. May assist patients with ancillary services such as but not limited to interpretation, appointment scheduling, transportation for the medical referral as indicated per department guidelines. 11. Collaborates with appropriate members of the care team to provide referral information. 12. Attends routine department meetings, trainings, and other meeting as required to maintain professional growth and comply with department guidelines 13. Assists in developing and implementing processes to improve quality within the referral department; assists in maintaining referral processes; makes recommendations for process changes as needed. 14. Answers question about appropriate documentation needed within the referral to connect patient to care; assists in educating and training new referral specialist staff on referral tasks; assists in educating clinicians and other internal staff regarding referral issues 15. Reviews referrals for completeness; searches for necessary records; follows up with clinicians and other members of the care team to obtain missing documentation, information or other required items needed to complete initial referral or close the loop on the referral 16. Creates a patient centered environment that promotes our willingness to say yes to patients. 17 - Answers telephone calls from patients and/or specialty office staff to assist the patient in ensuring they prepared for consult with specialty. 18. Processes prior authorization and referrals for diagnostic imaging as indicated by department guidelines and insurance network 19. Performs other duties as assigned.