Referral Care Specialist

Job Summary

The Outpatient Patient Access Referral Specialist coordinates all patient referrals made by Providers to appropriate specialties or for diagnostic services. Obtains and documents in patient records, receipt of certification and authorization from Third Party reimbursement companies (MCOs, HMOs, PPOs). Ensures providers have test results available in a timely manner. Completes follow-up referrals.

Job Summary

The Outpatient Patient Access Referral Specialist coordinates all patient referrals made by Providers to appropriate specialties or for diagnostic services. Obtains and documents in patient records, receipt of certification and authorization from Third Party reimbursement companies (MCOs, HMOs, PPOs). Ensures providers have test results available in a timely manner. Completes follow-up referrals.

Key Job Responsibilities

Essential Function

Collaborates with providers regarding patient diagnosis and need for referral.

Obtains all relevant patient information needed to make referral and obtains pre certification and/or authorization from appropriate MCOs/insurance agency.

Ensures proper ICD or CPT coding is completed on Referral Form. Ensures completeness of referral documentation form by provider.

Investigates appointment schedules and coordinates with patients regarding their availability and scheduling needs and in accordance with available appointment openings at specialties. Ensures appointment schedules are coordinated within established guidelines set by contracting agencies. Patient Appointment Reminder System.

Arranges for patient transportation prior to appointment.

Contacts Third Party Reimbursement/Certification Departments to obtain authorization for referral. Documents all communication on Referral/Certification Form and enters data into computerized referrals program.

Ensures completeness of all patient data/demographic information. Forwards necessary documentation to referring physician/diagnostic service.

Ensures that reports from consulting physicians, discharge summaries, diagnostic reports, etc. are received, reviewed and signed within two (2) weeks following appointment and filed appropriately.

Pending reports/results are followed up with referring agency and/or patient as appropriate. No show or rescheduled appointments are reported to the provider and documented in the patient’s chart on the referral form, along with the date of entry and the initials of the referral clerk.

Collaborates with the Community Outreach Coordinator regarding patient care follow-up and satisfaction level as it relates to referral.

Physical Demands

A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

N/A

Rarely

Occasionally

Frequently

Constantly

Weight

Standing X

Walking X

Sitting X

Lifting X

Carrying X

Pushing X

Pulling X

Climbing X

Balancing X

Stooping X

Kneeling X

Crouching X

Crawling X

Reaching X

Handling X

Grasping X

Feeling X

Talking X

Hearing X

Repetitive Motions X

Eye/Hand/Foot Coordination X

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