Clinical Referral Spec I

• Reviews work queues to identify unscheduled ordered services and connects with the patient to schedule the appropriate service.
• Schedules appointments including complex specialty appointments and adheres to appropriate protocols. Communicates to the patient all pre and post appointment instructions (i.e., medication guidelines, food/beverage consumption guidelines, check in procedures, directions to facilities, etc.). Schedules the ordered medical service accurately and links order to appointment.
• Responsible for providing provider referrals to patients based on the ordered medical service and patient’s preferences.
• Responsible for documenting all contact attempts to schedule the ordered medical service in the patient’s electronic health record and adhering to department workflows and procedures for contact attempts. Responsible for notifying the ordering provider through telephone encounter in electronic health record when an ordered medical service is removed according to the department’s assigned removal reasons.
• Provides the highest level of patient service by problem solving, documenting patient concerns, and identifying appropriate follow-up for patients. Educates patients regarding referral and authorization requirements, payer coverage, eligibility guidelines, and insurance related changes or trends.
• Performs registration responsibilities to ensure accurate patient information and confirms patient payer information.
• Maintains knowledge of the following and the associated reference material; Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and current accepted insurance plans.
• May obtain demographic and insurance information. May ensure insurance and patient information obtained is complete and accurate and update information if necessary. May update financial information and other data when changes or additions occur, and may communicate to patients as appropriate.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 1 year of experience in a medical group with focused experience in the coordination of patient care including scheduling of specialty services and comprehensive understanding of medical terminology.

Knowledge, Skills & Abilities Required:

• Knowledge of clinical processes and procedures, including a good working knowledge of medical terminology and medical chart documentation.
• Knowledge of patient focused software systems, (i.e. EPIC & Interactive Intelligence (I3)). Ability to efficiently enter/update database records and read/comprehend patient records.
• Excellent communication skills and the ability to communicate professionally and effectively with patients, peers, and caregivers across the organization.
• Demonstrated ability to work independently and be self-directed.
• Proficiency in Microsoft Office.
• Ability to manage multiple tasks.
• Excellent customer service skills.

Physical Requirements and Working Conditions:

• Exposed to a normal office environment.
• May require some travel, so there will be exposure to weather and road conditions.
• Operates all equipment necessary to perform the job.

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.