Referral Specialist

SUMMARY: Coordinates the AxessPointe Community Health Center, Inc. (API) patient referral process for specialty care as determined by the clinic’s medical providers, maintaining an established system of patient tracking and reporting.

SUPERVISOR: Health Center Administrator

DUTIES AND RESPONSIBILITIES:

• Coordinates all referrals to specialist practices and local-regional healthcare services.
• Process referral requests for patients for specialty services and diagnostic imaging.
• Provide appropriate customer service and answer patient inquiries.
• Maintain established tracking system of referrals--both external and internal.
• Provide information and support to medical providers regarding patient referrals.
• Uses sound judgment with patient scheduling efforts and utilization of resources.
• Documents and traces interaction with clients and appointments, assisting with data entry.
• Perform other duties as may be delegated by the Chief Compliance Officer or designee.
• Obtain current identification for managed care, prepare pre-certification as required including patient diagnosis as documented by primary care physician.
• Make appointments and request follow-up information.
• Review and explain process for referral to patient, including but not limited to what to expect, who providers are and how to get to hospital or referral specialist’s office.
• Review rejected requests for procedures or visits.
• Maintain up-to-date knowledge of referral guidelines, active providers, necessary coverage information, insurance requirements necessary for pre-certification.
• Maintain adequate records for risk management on referrals completed of patients needing to be seen outside of API.
• Compile monthly report for administrative review.
• Mail, fax or communicate appropriate records, certificates and authorizations to appropriate persons for the completion of the referral process.

Note: This job description is not intended to be an exhaustive list of all duties, responsibilities or qualifications associated with this job.

MINIMUM QUALIFICATIONS:

• General knowledge of the various specialty medical services in the northeast-Ohio area.
• Knowledge of medical terminology
• Excellent organizational skills including oral and written communication skills.
• Ability to work independently; excellent interpersonal skills; basic computer skills.
• Ability to relate to people from a variety of socio-economic and ethnic backgrounds.
• Prior medical office experience required with 1-3 years of related medical office and/or community experience considered.
• Must be self-motivated and organized.
• Previous referral experience preferred.
• Must be multi-tasked and complete duties with minimal supervision.

LICENSES OR CERTIFICATIONS REQUIRED:

• None.

COMPLIANCE:

This position requires compliance with API's written standards, including its Compliance Program and Standards of Conduct and policies and procedures. Such compliance will be an element considered as part of the regular performance evaluation.

Failure to comply with API's Written Standards, which may include the failure to report any conduct or event that potentially violates legal or compliance requirements or API's Written Standards or, for managers and supervisors, fails to detect non-compliant conduct where reasonable efforts would have resulted in detection, will be met by the enforcement of disciplinary action, up to and including possible termination, in accordance with API's Compliance Program Policy and Procedure: Addressing Instances of Non-Compliance through Appropriate Disciplinary Actions.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, and use hands to finger handle or feel; to talk; or hear. The employee is frequently required to reach with hands and arms. The employee must occasionally stand, walk, climb or balance, stoop, kneel, crouch or crawl. The employee must be able to frequently lift up to 25 pounds. The employee may occasionally be required to lift 25 to 50 pounds; however, this is not essential; duties may be shifted to accommodate lifting restrictions.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to use close vision (clear vision at 20 inches or less). The employee will occasionally be working near moving mechanical parts, be exposed to outdoor weather conditions and exposed to a risk of electrical shock while running the copier, printer, other standard equipment and answering the telephone. The noise level in the work environment is low to moderate. Stress level can be high at times.

Note: This job description is not intended to be an exhaustive list of all duties, responsibilities or qualifications associated with the job.