Patient Access Center - Referrals Specialist

Job Description

Job Description

COMMUNITY HEALTH:

Community Health is a primary care network that provides nationally-recognized programs, a focus on wellness, dental, behavioral health and pediatric specialties, walk-in Express Care, a culture of community and quality health care that almost everyone, insured or uninsured, has come to depend on. As an equal opportunity employer, we offer a team-oriented, collaborative work environment for close to 400 employees at eight different locations in Rutland and southern Addison counties.

ABOUT THE ROLE:

A Referrals Specialist manages the end-to-end processing of patient Referrals, Orders and Diagnostic. Our team acts as a liaison between primary care providers, patients, facilities, specialist offices and insurance companies as needed. This fast-paced department is committed to ensuring timely, authorized and documented care. Team members should be able to work independently when needed and be able to prioritize diverse responsibilities.

FUNCTIONS OF THE POSITION:

• Communication Liaison: Our team members are the primary point of contact between patients, providers and specialist offices for questions and information requests. Candidates must be able to provide effective and professional communication with efficient and comprehensive documentation.

• Outgoing Referrals / Orders: Team members must compile and review supporting documentation needed to support referrals, provide accurate information and be able to follow refer-to-facility protocols to ensure comprehensive and timely processing.
• Diagnostic Imaging; Key duties include timely processing of orders, verifying insurance information, and ensuring required documentation is complete. Team members act as the primary liaison between the referring provider, insurance companies and radiology facility to resolve questions, issues and delays
• Insurance & Authorization: Verify patient insurance coverage and obtain necessary pre-authorizations or pre-certifications for referrals, orders and diagnostic testing. Authorizations must be accurately recorded and relayed to facilities.
• Tracking & Documentation: Utilize Electronic Health Records (EHR) to track referrals, ensuring patient charts are updated with appointment information and consultant reports ("closing the loop").
• Maintains appropriate reports according to CHCRR policy, state and federal requirements.

• Other duties as assigned

SKILLS REQUIRED FOR SUCCESS:

• High school diploma or equivalent; Associates Degree preferred.
• Three years of experience preferred as a referral specialist or similar experience in a healthcare role.
• Knowledge of medical billing/coding, skills in using electronic medical record system, proficient computer skills, and strong customer service skills.
• Skill identifying problems and recommending solutions.
• Ability to communicate clearly.

HOW WE SUPPORT YOU:

• Work Life Balance
• Generous Time Off
• Medical, dental, and vision insurance.
• Health savings account option.
• Robust 403 (b) retirement savings plan, with employer match and 100% vesting schedule.
• Comprehensive Wellness Program.