Referral Specialist / Him Lead-Full Time

Major Responsibilities:
Referral Specialist
1)Coordinates the patient care needs for high risk patients (including diabetes and preeclampsia). Arranges for appropriate referrals and paperwork for specialty physician care, diabetic teaching and nutrition education, home visits, durable equipment needs, etc.

2)Responsible for coordination of managed care process

3)Handles the referral processing activities from the physician office side. This includes all the paperwork required for working within the established PHO procedures.

4)Works through eligibility and denial issues on behalf of the patient and physician.

5)Identifies and refers appropriate patients for disease management/case management programs.

6)Responsible for obtaining needed information to get needed referrals

7)Initiates the medical necessity review process as appropriate with the support of the physician.

8)Acts as a resource (advocate) for patients in working through the managed care process.

9)Handles the pre-certification process.

10)Continues to educate providers and clinical staff of managed care updates

Developmental responsibilities
1)Maintain current skill verification specific to their practice.

2)Maintain current CPR certification.

3)Attends in-service and other professional development opportunities.

4)Maintains CMA re-certification as required.

Health Information LEAD
1)Responsible for maintaing good work flow for the Health Information associates by scheduling them appropriate to meet budget FTE and assigning assignments.

2)Responsible for training all Health Information associates and ensures accuracy and completeness of all health information tasks performed by associates.

3)Updates and reviews compliance of protocols set up for the Family Practice Center Medical Records department.

4)Responsible for maintaining Chart Tracking system in IDX.

5)Responsible for all Health Information being requested for Release.

6)Responsible for forwarding inactive charts to off-site storage area.

7)Continues to inform and educate clinical staff and providers of health information education (ie: HIPPA)

8)Back up support as needed for: misc filing, pulling charts, answer phones and performs other Medical Records duties assigned (varies based on practice need).

Education/Experience Required:
• Completion of an LPN, Medical Assistant program, or equivalent experience. • Successful completion of certification exam for CMA or licensure as an LPN. • 3-5 years experience in ambulatory/ medical office.

Knowledge, Skills & Abilities Required:
• Clinically appropriate skills. • Ability to communicate clearly and effectively in caring manner. • Strong interpersonal & customer relations skills. • Good verbal and written communication skills. • Ability to work as a team player. • Good organizational skills. • Good problem-solving skills. • Ability to handle difficult calls and maintain professional conduct. • Flexible.
• LPN Licensure or Medical Assistant Certification. • Current CPR certification.

Physical Requirements and Working Conditions:
• Ability to handle multiple demands/tasks. • Ability to work under stressful conditions and in difficult situations. • Ability to perform lifting/transfer activities related to patients. • Knowledge of Universal precautions, Hazadous Waste procedures. • May require evening/Saturday hours to accommodate practice needs. • Risk of exposure to infectious disease.
If position has direct patient care or direct patient contact the following lifting requirement supersedes any previous lifting requirement effective 06/01/2015. Ability to lift up to 35 pounds without assistance. For patient lifts of over 35 pounds, or when patient is unable to assist with the lift, patient handling equipment is expected to be used, with at least one other associate, when available. Unique patient lifting/movement situations will be assessed on a case-by-case basis.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.