Patient Referral Specialist
1 week ago
Summary: The Patient Referral Specialist plays a crucial role in managing the flow of specialist referrals within the healthcare system.
Key Responsibilities:
- Oversee the coordination and processing of all patient referrals for specialized medical services.
- Ensure accuracy in collecting and verifying patient registration data, including demographic and insurance details.
- Act as a liaison between Community Medical Group and various healthcare providers, demonstrating exceptional customer service skills.
- Conduct eligibility verifications for members via phone or electronic means as required.
- Adhere to established protocols for obtaining necessary authorizations and processing all referral services, including securing approval from the medical director.
- Assist physicians and patients in scheduling appointments, obtaining authorizations, and coordinating tests across different clinics.
- Arrange appointments and transportation for patients as needed.
- Timely contact patients to fulfill all scheduling requirements.
- Communicate effectively with patients to ensure they follow through with their referrals.
- Maintain strict confidentiality of all health records and member information, complying with HIPAA regulations.
- Coordinate pre-admission testing with clinic staff and patients.
- Efficiently complete all administrative tasks related to referral activities.
- Input all referral, hospital, outpatient, and specialty health service authorizations into the computer system in accordance with CMG policies.
- Monitor referral reports for missing documentation and follow up promptly.
- Perform all duties with integrity and ethical standards.
- Execute additional responsibilities as assigned.
Qualifications:
- Education/Experience:
- High school diploma or equivalent required.
- Previous experience in a clinical environment preferred.
- Proficiency in MS Office applications.
- Medical Assistant training or certification is advantageous.
- Familiarity with medical terminology and coding systems such as CPT, HCPCS, and ICD is preferred.
- Experience with Electronic Health Records (EHR) is a plus.
Skills:
- Ability to assess compliance with laws, regulations, and standards using relevant information and sound judgment.
- Capability to work independently and complete assignments within established guidelines.
- Strong logical reasoning skills to evaluate solutions and approaches to problems.
- Professional and courteous interaction with individuals both within and outside the organization.
- Ability to build constructive and cooperative working relationships.
- Comprehension of written documents related to work.
- Strong independent judgment and initiative.
- Organizational skills to manage competing priorities effectively.
- Resourcefulness in problem-solving.
- Proactive in assisting others.
- Excellent written and verbal communication skills.
- Detail-oriented with a solid understanding of medical terminology.
- Strong organizational and interpersonal abilities.
- Knowledge of EHR systems.
- Bilingual skills (English/Spanish or English/Creole) are preferred.
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