Access Referral Specialist

Access Referral Specialist

The Access Referral Specialist is a vital member of the Access Center team, serving as the primary point of contact for answering all inbound calls, faxes, and emails from our referral partners, the community, and from Gilchrist staff which ensures the highest quality customer service in all referral development and management. This role supports the delivery of exceptional customer service and coordinates referral development and patient access for all Gilchrist service lines, including hospice, palliative care, and geriatric medical services. The Access Referral Specialist works under the supervision of the Access Center Manager, to ensure the delivery of high quality, professional, compassionate services in accordance with the mission and core values of Gilchrist. The Access Referral Specialist is accountable for establishing and maintaining relationships with patients, families, and referral sources responding to all customer requests and concerns; while possessing strong organizational skills, with emphasis on accurate and thorough documentation with a high degree of accuracy. The Access Referral Specialist facilitates the admission and appointment scheduling process for hospice patients, serving as the primary point of contact for referral sources. The Access Referral Specialist works cohesively with all organizational disciplines to facilitate hospice, palliative, and geriatric medical service admissions. The Access Referral Specialist will verify insurance coverage for all patients with Medicare/Medicaid and identify all applicable commercial insurance plans and coordinate with the clinical team for concurrent care review as needed. The Access Referral Specialist will utilize DocuSign to obtain signatures for patient consents and other required documentation as needed. The Access Referral Specialist will assist field staff with uploading documents to the EMR and obtaining consent signatures as requested. The Access Referral Specialist is cross-trained to perform the role of the Bed Coordinator when needed. The Access Referral Specialist will monitor the admission appointments for all Gilchrist entities for completeness, geographic efficiency and nurse schedules. The Access Referral Specialist will assist the Access Center Manager with revising workflows/processes, Epic reporting, and Epic Dashboard and Workqueue management. The Access Referral Specialist will be responsible for participating in mentoring and leadership development classes offered by the organization to enhance and expand their leadership skills. The Access Referral Specialist will manage data, and must be proficient in Windows, Excel, and Word interfaces. The Access Referral Specialist will be proficient in all Gilchrist programs.

Education

High School or the equivalent. Associate's or Bachelor's degree preferred.

Experience

Minimum of 3 years' experience with Gilchrist or equivalent experience in a complex health care call center required. Working knowledge of the health care environment and terminology preferred.

Knowledge, Skills and Abilities

• Strong phone skills to include excellent verbal and active listening.
• Able to manage conflict and resolve concerns from the community.
• Able to work well with other departments.
• Knowledge and ability to understand and accurately verify insurance benefits Medicare/Medicaid and all commercial insurance payors required.
• Prior experience with DocuSign or equivalent tool to obtain signatures for patient consents and other required documentation as needed.
• Understanding of the Condition of Participation, CHAP and other regulatory requirements for admission to hospice, palliative and geriatric services
• Ability to effectively work with nurses, physicians, nurse practitioners, social workers, and others.
• Detail oriented with a high degree of accuracy and reliability
• Strong computer skills
• Ability to multi-task, set priorities, and manage time effectively.
• Demonstrated empathy, genuine concern, and passion for helping customers.
• Strong assessment skills to identify the customer's needs, clarify information, research issues, and provide resources and information that best meet assessed needs.
• Adept at EPIC and able to make recommendations for build outs to meet needs, run reports, analyze data, and implement process improvement changes to improve quality of services.
• Ability to work on site and in emergency weather and other situations required.

Principal Duties and Responsibilities:

• Is knowledgeable about all Gilchrist programs and services and assists callers to enroll in the best program to meet their needs.
• Is knowledgeable of and is proficient in all regulatory requirements for our all Gilchrist programs and services
• Schedule visits for all inquiry and referral callers for all Gilchrist programs and services
• Accurately records referral information for business tracking and management
• Follow policies and procedures for admissions management
• Schedule admission visits within required timeframes
• Conducts impeccable follow through for and with customers including both internal and external customers
• Demonstrates impeccable customer service and achieves targets for metrics
• Maintain accurate pending referral list and communication
• Dispatch visits to Gilchrist providers, Access RN's and Hospital Liaisons
• Dispatch information and coordinate visit schedules for visiting pre-admission staff
• Assures timely follow-up on all pending patients and non-admits
• Facilitate processing of admission documents from referral call through transfer to appropriate care team
• Document all call information according to standard operating procedures within the Epic record
• Communicate prospective patient updates to appropriate referral sources and internal stakeholders for unit placement
• Communicate with referral source, DME, pharmacy and other vendors to process all certifications, orders, and required admission information
• Coordinates patient services such as scheduling ambulances and home medical equipment needed for a complete and safe admission to service.
• Is trained in bed management and can fill in as needed in this role.
• Mentors and trains new team members in all aspects of the work
• Provides feedback and coaching to all assigned mentees.
• Enter prospective and admitted patient demographic information and status updates in the Epic database
• Obtain information and accurately complete all documentation, forms and logs for referral calls and admissions processing. All data entered into the Epic system
• Works the Epic work queue's as outlined in standard work documents
• Helps resolve referral and admissions management issues and complaints through direct communication with referral sources and admissions team. Escalates unresolved issues to the Access Center Manager
• Works on special projects that are important to area/process improvement
• Reverifies physician licensure as needed
• Make follow-up calls for referral inquiries within required time
• Ensures compliance with all state, federal and CHAP requirements
• Generates and electronically files appropriate patient-related information for the medical record consistent with company policy and regulatory requirements
• Runs Daily Epic Admission and Referral Reports, monitors and maintains the Epic Pending Admission report.

Physical Requirements

• Ability to concentrate and pay close attention to detail when typing, proofreading, and completing assignments and driving.
• Ability to lift up to ten (10) pounds maximum and occasionally lift and/or carry small item
• Ability to stand and walk occasionally to perform the essential functions of the job at random intervals.

Working Conditions

• Normal office environment

GBMC Values

All Roles Must Demonstrate the GBMC Values:

Value Description

Respect

I will treat everyone with courtesy. I will foster a healing environment.

• Treats others with fairness, kindness, and respect for personal dignity and privacy
• Listens and responds appropriately to others' needs, feelings, and capabilities

Excellence

I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.

• Meets and/or exceeds customer expectations
• Actively pursues learning and self-development
• Pays attention to detail; follows through

Accountability

I will be professional in the way I act, look, and speak. I will take ownership to solve problems.

• Sets a positive, professional example for others
• Takes ownership of problems and does what is needed to solve them
• Appropriately plans and utilizes required resources for various job duties
• Reports to work regularly and on time

Teamwork

I will be engaged and collaborative. I will keep people informed.

• Works cooperatively and collaboratively with others for the success of the team
• Addresses and resolves conflict in a positive way
• Seeks out the ideas of others to reach the best solutions
• Acknowledges and celebrates