Community Referral Specialist

Community Referral Specialist

The Community Referral Specialist will manage all incoming referrals from a selection of key referral sources. They will evaluate referrals for admission to PruittHealth leveraging clinical experience and an understanding of Home Health agencies. We are looking for someone with a clinical background interested in helping patients get the opportunity to obtain services by PruittHealth and support Community Relations Representatives sustain business partnerships with referral sources. In this cross-functional role, the Community Referral Specialist will engage with partners across disciplines, from external hospitals and healthcare systems to Pruitt administrators, clinical managers, and Community Relations Representatives.

Key Responsibilities:

• Review patient referrals and respond on behalf of PruittHealth meeting productivity response expectations.
• Accurately completes referral documentation as necessary to facilitate the admissions process. This position maintains a 1% or less data entry error.
• Manages incoming calls and responds before the third ring.
• Assigns the appropriate next person in the referral management process.
• Verifies insurance and eligibility if assigned.
• Works closely with clinical team until admission is scheduled.
• Attends morning huddle calls.
• Collaborates with revenue cycle team to ensure understanding of payors and requirements affecting verification/authorization.
• Escalate issues or barriers to manager.
• Reviews physician orders and follows up with referral source for clarifications or additional information if needed.
• Identifies objections, concerns, or other entry barriers and provides information in response to address those issues. Proactively offers alternatives if the agency is unable to provide services.
• Processes and documents referrals that are not accepted for admission, indicating specific reason for non-acceptance.
• Access multiple electronic health systems to receive referrals
• Understand daily agency statuses across staffing, payor, and clinical abilities and manage points of contact across assigned agencies.
• Partner closely with sales partners, admins, and clinical managers
• Support further processing referrals, vet payors, and conduct welcome calls when needed
• Perform other related duties as necessary and as directed by supervisor

Knowledge, Skills, Abilities:

• Fluent with all Regulatory agencies, reimbursement systems and levels of care.
• Must be knowledgeable of private insurance and Medicare coverage criteria, rules and regulations.
• Assists in the evaluation of patients to ensure that they are appropriate for admission.
• Taking responsibility for a regional territory of Hospitals and community services in order to facilitate placements within the network of providers.
• Communicating referral needs within our structure and facilitating admissions into the network of providers.
• Must provide excellent Customer Service to all referral sources and network of providers if conducting outreach in support of the Community Relations Representative.
• Ensure we obtain all documentation necessary to support the focus of care.
• Be able to learn how to use multiple electronic health systems and platforms to receive referrals.
• Attend and participate in continuing educational programs to keep abreast of changes in your field as well as to maintain current license/certification, as required.
• Honor patients/residents' rights to fair and equitable treatment, self-determination, individuality, privacy, property and civil rights, including the right to wage complaints.
• Communicates well with patients/residents/clients and family members providing warm and friendly greeting and an approachable attitude to families, visitors, patients/residents/clients and responds to expressed concerns while displaying a helpful, caring demeanor. Answers questions when appropriate in a professional manner.
• Commits to high ethical standards and complies with the Code of Conduct, state and federal regulations, accreditation standards, and policies and procedures; maintains confidentiality of patient and employee records and information; has a duty to report compliance concerns, significant legal risk questions, fraud, abuse, suspected or actual misconduct to management.

Minimum Education Required:

High School Diploma or equivalent

Minimum Experience Required:

One (1) year experience working in a healthcare environment, or any equivalent combination of experience and training which provides the required knowledge, skills, and abilities.

Minimum Licensure/Certification Required by Law:

n/a

Additional Qualifications:

- Clerical and Computer skills required including experience with data entry EPIC/Wellsky, Mosia and MatrixCare a plus

- Knowledge of basic medical terminology

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.