Referral Specialist

Job Description

Job Description

ORGANIZATION INFORMATION:

Established in 1984, Equitas Health is a regional not-for-profit community-based healthcare system and federally qualified community health center look-alike. Its expanded mission has made it one of the nation’s largest HIV/AIDS, lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) healthcare organizations. With 22 offices in 12 cities, it serves more than 67,000 individuals in Ohio, Kentucky, and West Virginia each year through its diverse healthcare and social service delivery system focused around: primary and specialized medical care, retail pharmacy, dental, behavioral health, HIV/STI prevention, advocacy, and community health initiatives.

HOURLY RATE:$18.13-$21.78

BENEFITS:

• PTO
• Vision
• Dental
• Health
• 401k
• Sick time
• Paid Holidays

POSITION SUMMARY: The Referral Specialist supports the mission and core values of Equitas Health through responsible and effective work performance by providing support to clinical staff in order to facilitate the administrative components of clinical referrals for various services. ESSENTIAL JOB FUNCTIONS: Essential job functions include effectively communicating with internal and external customers including medical providers, clinic staff, and insurance companies, and maintaining ongoing tracking and appropriate documentation on referrals and authorizations via computer system and/or manual systems. MAJOR AREAS OF RESPONSIBILITIES:

· Screen and schedule incoming referrals.

· Obtain prior authorization for diagnostic services and procedures.

· Answers questions from patients, clerical staff, providers and insurance companies.

· Answers, responds and documents phone calls, request and questions from patients in a timely manner. Calls must be accurately managed or redirect as appropriate.

· Responds to in-house provider and clinical staff questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.

· Notifies the client of appointments scheduled, makes follow-up calls to off-site providers to ensure that client kept appointment.

· Maintains competency in obtaining and inputting medical information to and from clinical and /or other information systems including accessing information as required to complete the referral process.

· Verifies insurance coverage and obtains authorizations if needed from insurance coverage.

· Enters referrals and documents communications, actions, and other data in EPIC daily.

· Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.

· Maintains an accurate records of external referral patient's appointments that are kept, failed, and current status in the Referral Management System (EPIC)) .

· Documents efforts to reschedule patients and provide documentation in EMR/Referral Management Data base, as appropriate.

· Routinely makes reminder phone calls, reminder to referral patients in advance of appointment with outside providers.

· Responds to in-house provider and clinical staff questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.

EDUCATION/LICENSURE:

· High School diploma or GED.

KNOWLEDGE, SKILLS, ABILITIES AND OTHER QUALIFICATIONS:

· Three years of customer service experience and clerical experience in a medical facility

· Knowledge of clinical/medical office procedures and Medical Terminology.

· Ability to be flexible and relate well with others in a professional and pleasant manner

· Experience with EMR. Epic experience preferred.

· Previous insurance verifier, pre-authorization and/or medical receptionist experience.

· Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians, staff members and the public.

· Excellent organizational skills with an ability to prioritize and manage multiple tasks.

· Ability to work efficiently without constant supervision and exercise a degree of initiative and judgment.

· Must have sensitivity to, interest in and competence in cultural differences, HIV/AIDS, minority health, sexual practices, and a demonstrated competence in working with persons of color, and gay/lesbian/bisexual/transgender community.

· Ability to maintain confidentiality.

OTHER INFORMATION:

Background and reference checks will be conducted. In accordance with Equitas Health’s Drug-Free Workplace Policy, pre-employment drug testing will be administered. Hours may vary, including working some evenings and weekends based on workload. Individuals are not considered applicants until they have been asked to visit for an interview and at that time complete an application for employment. Completing the application does not guarantee employment. EOE/AA