POPULATION HEALTH SPECIALIST

POSITION SUMMARY:

Under the direct Supervision of the Referrals Supervisor, the Population Health Specialist (PHS) plays a crucial role in managing and facilitating the referral process within JPAFHC. PHS primary responsibilities involve facilitating and managing the entire process of referrals from initiation to completion. By effectively managing these duties, a PHS helps ensure that patients receive timely and appropriate care, and healthcare providers can collaborate seamlessly to address the patient's needs. This contributes to overall patient satisfaction and enhances the quality of care provided.

RESPONSIBILITIES:

Observes and preserves all HIPPA rules and regulations in the maintenance of Patient Confidentiality.

Patient Involvement:

1. Communicates with patients and staff in a prompt, professional, positive, and courteous manner, stating employee’s name and JPA location. (Inbound/ Outbound calls).
2. Educates patients on the referral process, including required documentation and steps to follow.
3. Handles special telephone tasks, such as call transfers, creating telephone encounters, callbacks, holds, interruptions, and unintentional disconnects, and directs incoming calls to appropriate resources (Clinic, Department, or individual to provide follow-up).
4. Reports patient inquiries and complaints, as appropriate, to immediate supervisor, and creates a Telephone Encounter to record patient’s requests, as needed.

Referral Process:

1. Processes Referrals to specialty areas for PCP physicians or consulting physicians.
2. Monitors the progress of referrals and tracks the status of appointments and diagnostic tests.
3. Addresses any issues or delays in the referral process and takes appropriate action to resolve them.
4. Verifies that all necessary information is included in the referral, including patient details, medical history, and reason for the referral.
5. Contacts patients to inform them of referral status, provides necessary details, and schedules appointments with specialists or other healthcare providers.
6. Maintains accurate and up-to-date records of all referrals, ensuring that essential information is documented in the patient's medical records or referral management system.
7. Answers incoming phone calls regarding questions about referrals.
8. Collaborate with various departments such as Adult, OB-GYN, PEDS clinical staff, front office, medical records, and billing to ensure a smooth referral process

Authorization:

1. Contacts insurance companies for authorization of procedures and specialty appointments.
2. Updates CPT Codes

Closure and Reporting:

1. Ensure that the referral loop is closed by obtaining feedback from the referred providers and updating the patient's medical records accordingly.
2. Reviews reports on referral activity, closure rates, and any outstanding or unresolved referrals.
3. Follows up with patients to ensure they attend the scheduled appointments.
4. Communicates with healthcare providers to gather feedback on the outcomes of referrals.

Quality Assurance:

1. Will work closely and collaborate with the quality team, clinical leadership, and operations to implement a centralized approach for outreach activities in support of enhancing and maintaining performance on quality measures; this includes HEDIS and other value-based care quality, cost, and utilization measures.
2. Ensure that the referral process meets established standards and regulatory requirements.
3. Will maintain effective quality outreach and patient engagement strategies to improve performance.
4. Will collaborate with VP of Population Health on identifying areas of improvement and exploring opportunities for the development of best practices related to care gap closure.
5. Leveraging all available tools – including EMR and insurance company portals, to provide direction for targeted outreach to patients and update as needed.
6. Sharing findings of identified concerns or improvements related to gap closure, ordering process, and documentation with management and participating in the process improvement of the workflow
7. Training/Additional Duties:
8. Successfully completes all required job-related training and corresponding assessments conducted by JPA or designated entity
9. Perform additional duties as required.

MINIMUM QUALIFICATIONS:

1. Associate degree in healthcare management or related field.
2. Four-year experience in Clinic setting preferred
3. Previous experience as a referral clerk or in a similar based clerical role is required
4. Strong computer knowledge including Microsoft Word, Excel, SharePoint and Outlook required.
5. Aptitude for data entry and typing
6. Bilingual preferred (English/Spanish)
7. Excellent verbal and written communications skills
8. Exceptional active listening skills
9. Display positive customer service
10. Sensitivity towards cultural diversity
11. Ability to work with diverse racial, linguistic, cultural and sociodemographic populations
12. Ability to work independently and as a team
13. Ability to multitask
14. Dependable and punctual