Referral Specialist en None

1. Position Summary:

Under the direction of the Director of Population Health, the Referral Specialist will coordinate, process and schedule referrals, prior authorizations and pre-certifications for assigned healthcare providers.  This position requires the use of clinical and administrative judgment and initiative to determine best approach for both urgent and non-urgent patient care needs. Also required are excellent time management skills and self-motivation to complete assigned tasks.

II.         Essential Functions/Responsibilities:

• Monitors electronic referral requests and imaging orders in the EMR throughout the day to process requests 
• Prepares and processes all referral and imaging prior authorization and pre-certification requests that are not urgent or in-house referrals and/or imaging
• Gathers pertinent information as needed via EMR or from clinical team and provides appropriate clinical information to specialists (ie. Encounter notes, Labs, Imaging)
• Utilizes third party payer/insurance portals for authorization approval
• Reminds patient of scheduled referral appointments electronically, by mail or phone when required
• Utilizes EMR functions to document all pertinent information
• Communicate effectively with clinical staff and providers when additional information is needed to process request
• Organizes and prioritizes workload based on acuity
• Contact patients concerning pending referrals and or diagnostic testing when required
• Assist clinical team when needed concerning urgent imaging requests and urgent referrals
• Participates as a member of the Population Health Department
• Assist with referral follow up as needed
• Perform other duties as required and/or directed.

1. Skills/Certifications:

• The ability to interact effectively with patients, family supports, community resources and staff.
• Must be certified in Basic Life Support techniques.
• Ability to prioritize multiple tasks and perform efficiently and effectively in a stressful environment.
• Ability to acquire knowledge of the policies, procedures and programs.
• Knowledge of CPT/ICD-10 codes, insurance authorization processes including health plan requirements for prior authorization and pre-certification.
• Bilingual
• Ability to work effectively with associates, as well as with supervisors, in the various units of the organization.
• Ability to work in a team relationship.
• Two years physician office billing, registration or scheduling or
• One year as a Medical Assistant in a clinical patient care setting
• Experience working with diverse population groups
• Time management and self-motivation skills required
• Experience with Athena EMR 

1. Education Required:

• Successful completion of High School with diploma or equivalent
• Certified Medical Assistant or Certified Nursing Assistant with clinical experience preferred
• Previous experience as a Referral Specialist preferred