Patient Referral Specialist

1 week ago


Miami, Florida, United States Community Medical Group Full time
Position Overview

Summary: The Patient Referral Specialist plays a crucial role in managing the flow of specialist referrals within the healthcare system.

Key Responsibilities:

  1. Oversee the coordination and processing of all patient referrals for specialized medical services.
  2. Ensure accuracy in collecting and verifying patient registration data, including demographic and insurance details.
  3. Act as a liaison between Community Medical Group and various healthcare providers, demonstrating exceptional customer service skills.
  4. Conduct eligibility verifications for members via phone or electronic means as required.
  5. Adhere to established protocols for obtaining necessary authorizations and processing all referral services, including securing approval from the medical director.
  6. Assist physicians and patients in scheduling appointments, obtaining authorizations, and coordinating tests across different clinics.
  7. Arrange appointments and transportation for patients as needed.
  8. Timely contact patients to fulfill all scheduling requirements.
  9. Communicate effectively with patients to ensure they follow through with their referrals.
  10. Maintain strict confidentiality of all health records and member information, complying with HIPAA regulations.
  11. Coordinate pre-admission testing with clinic staff and patients.
  12. Efficiently complete all administrative tasks related to referral activities.
  13. Input all referral, hospital, outpatient, and specialty health service authorizations into the computer system in accordance with CMG policies.
  14. Monitor referral reports for missing documentation and follow up promptly.
  15. Perform all duties with integrity and ethical standards.
  16. Execute additional responsibilities as assigned.

Qualifications:

  1. Education/Experience:
  2. High school diploma or equivalent required.
  3. Previous experience in a clinical environment preferred.
  4. Proficiency in MS Office applications.
  5. Medical Assistant training or certification is advantageous.
  6. Familiarity with medical terminology and coding systems such as CPT, HCPCS, and ICD is preferred.
  7. Experience with Electronic Health Records (EHR) is a plus.

Skills:

  1. Ability to assess compliance with laws, regulations, and standards using relevant information and sound judgment.
  2. Capability to work independently and complete assignments within established guidelines.
  3. Strong logical reasoning skills to evaluate solutions and approaches to problems.
  4. Professional and courteous interaction with individuals both within and outside the organization.
  5. Ability to build constructive and cooperative working relationships.
  6. Comprehension of written documents related to work.
  7. Strong independent judgment and initiative.
  8. Organizational skills to manage competing priorities effectively.
  9. Resourcefulness in problem-solving.
  10. Proactive in assisting others.
  11. Excellent written and verbal communication skills.
  12. Detail-oriented with a solid understanding of medical terminology.
  13. Strong organizational and interpersonal abilities.
  14. Knowledge of EHR systems.
  15. Bilingual skills (English/Spanish or English/Creole) are preferred.


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