Referral Specialist Full-Time

Referral Specialist
Position Type: Full Time Job Shift: Day Education Level: High School Travel Percentage: None Category: Health Care
We are an EEO employer, and all hiring practices and other terms and conditions of employment shall be maintained and conducted in a manner that ensures compliance with all applicable federal laws.
This position is responsible for performing duties associated with patients being referred by their Hamilton Community Health Network primary care physicians to specialists or institutions for additional health care. Understands that employment is contingent upon adherence to HCHN policies and procedures, the mission of the organization, JCAHO policies and procedures, OSHA standards and all other safety and health codes and laws.
Researches the patient's managed care organization plan to ensure that the referral is made to the proper provider within the patients network.
Responsible for following the guidelines as determined by each managed care plan specific to their referral process and for obtaining the appropriate authorizations. Obtaining appropriate demographic identification for each managed care plan and utilizing specific forms/data entry as specified.
Preparing authorization with patient diagnosis and request from the primary care physician any other need information.

Weekly responsible for maintaining and updating their individual referral specialist log.
Maintaining the networks excel spreadsheet for every referral completed and ensuring that required data is updated.
Documenting attempts made to secure the consults as well as information regarding patients compliance with appointments.
Documenting if patient kept specialist appointment or if a second appointment is needed.
For missed appointments, the referral specialist will schedule new appointments.
Following up to ensure that consults are received for those appointments kept by requesting the consultants from the specialist if it is not received within 7 calendar days.
Attend seminars or training sessions as appropriate for new managed care programs and/or for updates on existing programs.
Maintain up-to-date information of referral guidelines, active providers, necessary coverage information, and private insurance requirements necessary for pre-certification or outside referral as well as other related information.
Answer questions from HCHN patients requesting referral assistance and/or from referring physicians to ensure efficient patient referral and complete patient information. Status of referral authorizations sent to the specialist.
Patient information, such as current medication list and problem lists are sent to the specialist.

Functions as the liaison with referral sources, managed care representatives, patients, and physicians concerning the network of care is overseen by primary care providers in Hamilton Community Health Network.
Mail, fax, or communicate additional, appropriate records, certificates, and authorizations to appropriate persons for the completion of the referral process as required by managed care providers.
Ability to evaluate patients response to care through observation.
Professionally handles patient complaints.
High School Diploma or G.Some college preferred. Previous experience working with a managed care referral process preferred. Two years clerical experience with strong secretarial/computer skills and one year experience as clinical support in a health care setting required. Must have proven knowledge of Medicaid and managed care insurance programs. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Ability to provide excellent customer service skills.
Ability to use the telephone and computer.
Ability to meet all attendance and punctuality requirements to ensure proper coverage and quality service.
General computer proficiency.
Takes pride in job performance as evident in compliance with job responsibilities.
Assumes responsibility for work performance and is able to be self-directed.
Participates in staff meetings, training and committees.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Internal office space inside clinic area.