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Clinical Referral Specialist II

2 months ago

Milwaukee, United States Advocate Health Full time
Major Responsibilities:
  • Reviews work queues to identify unscheduled ordered services and connects with the patient to schedule the appropriate service. Confirms and secures authorization or required pre-certifications for patients to receive specialty consultation or medical services, and closes the referral if an authorization is not required.
  • 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. Coordinates the scheduling of all external referrals with non-aurora specialists in accordance with Medical Group guidelines and completes authorization responsibilities if necessary.
  • 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.
  • 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. Performs registration responsibilities to ensure accurate patient information and confirms patient payer information.
  • Educates patients and clinical caregivers regarding referral and authorization requirements, payer coverage, eligibility guidelines, and insurance related changes or trends. 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.
  • Responsible for management of EPIC In-Basket and management of requested authorizations across the system to include special requests (ex. Vision Therapy or authorization needed verification requests).
  • Provides weekly/timely updates to team lead and department leadership on issues to include escalation of in-house provider or caregiver questions, requests or concerns regarding the status of a patient's ordered service or care coordination.
  • Serves as an on-site resource for new and existing caregivers to the department for questions related to work queue process, authorization status and mentorship opportunities.

Licensure, Registration, and/or Certification Required:
  • None Required.

Education Required:
  • High School Graduate.

Experience Required:
  • Typically requires 2 years 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 and six months of experience as a clinical referral specialist I.

Knowledge, Skills & Abilities Required:
  • Knowledge of clinical processes and procedures, including a good working knowledge of medical terminology and medical chart documentation.
  • Advanced knowledge of referral management and electronic health record software system.
  • 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.