Referral / Medical Records Specialist

Job Summary

Under general supervision, the Referral/Medical Records Specialist is responsible for supporting patient care coordination and health information management functions at RGH Clovis Clinic by way of processing referrals, medical record scanning, and providing phone and registration coverage. This position serves as a key point of contact for patients, families, providers, and external healthcare partners while ensuring accurate management, processing, and release of patient medical records.

The Referral/Medical Records Specialist coordinates patient referrals and obtains prior authorizations for diagnostic services and procedures while assisting patients in navigating services both within RGH Clovis Clinic and with outside providers. In addition, this position ensures medical records are accurately retrieved, scanned, indexed, analyzed, and maintained in compliance with hospital policies and all applicable state and federal regulations, including HIPAA.

This role supports patient access to care, protects the integrity and confidentiality of health information, and assists in ensuring medical records are complete and available to support quality patient care, regulatory compliance, and accurate reimbursement. The Referral/Medical Records Specialist embodies the mission, vision, and values of Roosevelt General Hospital & Clinics while providing excellent customer service and administrative support.

Essential Job Responsibilities

• Promote the mission, vision, and values of the organization.
• Greet patients, families, and visitors in a professional and courteous manner and assist them in navigating hospital and clinic services.
• Perform patient registration functions including collecting and verifying demographic information, insurance information, and required documentation.
• Verify insurance eligibility and ensure patient information is accurate within the electronic medical record (EMR) system.
• Explain required registration forms, obtain appropriate signatures, and ensure completion of required patient documentation.
• Coordinate incoming and outgoing patient referrals to internal departments and external providers.
• Obtain prior authorizations for diagnostic services, procedures, and specialty services as required by insurance providers.
• Schedule referral appointments and notify patients of appointment details.
• Serve as a liaison between patients, providers, departments, and external healthcare partners regarding referrals, authorizations, registration, and medical record requests.
• Conduct follow-up communication with outside providers to confirm appointments and obtain consultation reports when applicable.
• Maintain competency in obtaining, entering, retrieving, and updating patient information within electronic medical record and information systems.
• Maintain strict confidentiality and safeguard protected health information in compliance with HIPAA regulations.
• Perform document management activities including batching, scanning, indexing, quality review, and releasing documents to the legal medical record.
• Conduct medical record analysis to insure documentation is complete and accurate before scanning.

• Monitor medical records for prompt completion to support documentation, coding, and reimbursement processes.
• Utilize software systems for ICD and CPT coding when required for referrals or documentation processes.
• Answer departmental phone calls, respond to voicemails within 24 hours (excluding weekends), and relay messages to appropriate staff.
• Provide general information regarding RGH services and assist patients in accessing appropriate care.
• Retrieve documentation from hospital departments and affiliated clinics as needed.
• Perform system support functions including password management, adding or modifying user profiles, managing document types, adjusting document indexes, maintaining record review groups, monitoring workflow queues, managing workflow permissions, and supporting printing, faxing, and email maintenance.
• Maintain accurate documentation and records in accordance with hospital policies and regulatory requirements.
• Establish and maintain positive working relationships with hospital departments, providers, and external healthcare partners.
• Provide excellent customer service to patients, staff, and external partners.
• Assist other members of the department as needed to support efficient operations.

Non-Essential Functions

Performs other duties as assigned.

Roosevelt General Hospital (RGH) is committed to providing safe, quality care to patients. Employees are required to adhere to the Values of RGH.

Integrity

We are committed to honesty and ethical principles, where our words and actions reflect our dedication to fostering strong relationships and maintaining professional credibility. We take accountability for our actions and their impact on others, consistently honoring our commitments and upholding moral standards and values in every situation.

Learning

We promote personal growth and professional excellence by embracing continuous learning through training, mentorship, and constructive feedback. We foster a collaborative culture driven by curiosity and critical thinking, encouraging staff to ask questions, seek answers, and share knowledge.

Innovation

We confidently embrace changes in technology, processes, and practices, encouraging strategic risk-taking and creativity to enhance healthcare delivery, patient safety, and the quality of care. We collaborate with partners from other hospitals, academic institutions, industry leaders, and community organizations to promote continuous improvement and remain at the forefront of advancing healthcare outcomes.

Kindness

We engage in open communication with patients, families, and colleagues to understand their needs and concerns, while respecting their differences and upholding their dignity. We foster a nurturing environment where individuals feel supported, understood, and valued, strengthening relationships, promoting growth, and enhancing the overall well-being of all. Excellence We strive to be a model rural healthcare facility, setting high standards in healthcare delivery and ensuring exceptional patient satisfaction within the communities we serve. We take pride in our accountability and fiscal responsibility, skillfully balancing costs and outcomes to guarantee that superior patient care is always delivered.

Unity

We collaborate across departments and disciplines to deliver effective and compassionate healthcare, working alongside patients, families, and community partners to ensure seamless coordination of care and achieve our common goals of wellness and healing. We prioritize open communication and mutual respect, empowering our teams to collaborate effectively by acknowledging and celebrating the unique contributions and strengths of each individual.

Qualifications

High school graduate or equivalent.

General computer knowledge. Previous hospital experience preferred.

Professional Requirements

• Adhere to dress code, appearance is neat and clean.
• Complete annual education requirements.
• Maintain patient confidentiality at all times.
• Report to work on time and as scheduled.
• Wear identification while on duty.
• Maintain regulatory requirements, including all state, federal and local regulations.
• Represent the organization in a positive and professional manner at all times.
• Comply with all organizational policies and standards regarding ethical business practices.
• Communicate the mission, ethics and goals of the organization.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings and in-services.

Knowledge, Skills, and Abilities

• Knowledge of health information management services
• Must have an enthusiastic and positive attitude
• Possess a genuine desire to help RGH become an exemplary hospital in the surrounding community and the state
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
• Ability to manage multiple and simultaneous responsibilities and to prioritize duties/tasks Ability to initiate communication with patients, their families and hospital visitors
• Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families
• Must have a professional demeanor and excellent public relations skills
• Willingness to develop or improve public speaking skills
• Must have excellent written skills with knowledge of medical terminology
• Must be dependable and on time
• Possess good 'people skills' for building relationships with colleagues at all levels
• Ability to plan and prioritize workload to meet deadlines
• Physical Requirements and Environmental Conditions Work is performed during regular work hours, but may require overtime and/or weekend hours to meet deadlines
• Work in varying degrees of temperature (heated or air conditioned)
• Work under extreme pressures
• Position requires sitting for approximately 4-8 hours per day with walking up to for 2 hours per day
• Position requires light to moderate work with 50 pounds maximum weight to lift and carry
• Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing

Physical Requirements and Environmental Conditions

• Work is performed during regular work hours, but may require overtime and/or weekend hours to meet deadlines
• Work in varying degrees of temperature (heated or air conditioned)
• Work under extreme pressures
• Position requires sitting for approximately 4-8 hours per day and walking for 2 hours per day
• Position requires light to moderate work with 50 pounds maximum weight to lift and carry
• Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing