referral specialist

SUMMARY: The Referral Specialist reports to the Business Manager, Rehabilitation Services. Under the general supervision, ensures the quality of the patient registration and scheduling process is upheld to departmental standards. Evaluates the incoming referral for information that is accurate and appropriately reflects the patient symptom to the requested treatment. Ensures quality control of the referral process is upheld by reviewing the accuracy and timeliness of referrals through monthly standard reports. Coordinates the effective and efficient processing and scheduling of all incoming referrals, adhering to established timelines and departmental procedures. Ensuring proper authorization is obtained and monitored during course of patient’s treatment. Coordinating with insurance companies to keep authorizations active. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: pReceives and reviews all incoming referrals ensuring completeness and accuracy. Ensures all information is received including patient demographics, insurance and authorizations, keeping all authorizations active during treatment and communicating as needed with the insurance company. Communicates promptly with referring provider and/or patient regarding insurance coverage issues (e.g. non-participation status) so the patient may seek timely services elsewhere.ppEvaluates and determines triage when reviewing the referral by following established clinic referral guidelines for complete/compliant information and proper provider scheduling.pDetermines if referral needs additional clarification, evaluates the content matter to services requested and proceeds with authorization and scheduling.ppReturns incomplete/non-compliant referrals based on triage guidelines to referring physician office indicating the reason for return.ppEnsures quality control of the referral process is upheld by reviewing the accuracy and timeliness of referrals through Monthly standard reports.ppProvides accurate and timely communication during the authorization process with patient and insurance company as needed.ppPerforms at benchmarked levels related to accuracy, productivity, quality and customer service as defined by industry standards and internal quality management.ppCoordinates and provides guidance to Outpatient Service Representative (OSR) or other staff to ensure proper registration and scheduling. Assists and provides support to staff when entering all referral information into the electronic health record (EHR) for any external referrals received including demographics, reason for referral and insuranceuthorization information. Scans referrals received by fax and/or on paper into the appropriate section of the referral record.ppDocuments any communication with referring providers, patients and/or Clinic (MD, RN, etc.) in the HER and documents all insurance information into Cedaron documentation system.ppResponds to incoming telephone calls regarding pending referrals, including timely response to voicemail messages.ppCoordinates and provides support when scheduling all referral appointments established by practice protocols and specifically those that require prior authorization.ppMaintains current knowledge of insurer referraluthorization requirements, have a working understanding of the patient population, and demonstrate cultural awareness and sensitivity. Documents all insurance information in Cedaron and monitors as treatment progresses.ppSchedules appointments according to triage guidelines. Ensures all demographics information is updated, insurance verified and authorizations obtained. Notifies patients of appointment, explains and educates patient to a level of understanding for the preparation needed for the upcoming appointment. Communicates with referring providers and ensures documentation of that communication in the EHR.ppDocuments all communication with patients in the EHR. Communicates with referring providers when patients decline appointments and/or do not keep their appointments. Refers patients to the Patient Financial Advocate when necessary.ppActs as a liaison/resource with patients, referring providers, community providers and practice team members regarding referral issues utilizing the highest level of customer service.pConsistently monitors clinic schedules to ensure maximized scheduling and fills any available/open timeslot including those appointments cancelled and/or rescheduled.pNotifies Provider and/or Manager if unable to schedule referral or if there are access issues.ppMonitors Referral Work-Queues and ensures that all referrals have been processed accordingly. Monitors denial Work-Queues and addresses issues as needed.pPerforms other duties as assigned. MINIMUM QUALIFICATIONS: pBASIC KNOWLEDGE:pAssociate degree in health information technology or related field or the equivalent experience in an ambulatory setting. Formal education in medical terminology, anatomy and other coding-related course.ppEXPERIENCE:pTwo years of clinical referral experience required and/or at least one year of related experience in coding/billing and medical record operations in an ambulatory care facility Health Information/Medical Record Department. Familiarity and understanding of the content of the medical record. Spanish speaking strongly preferred. Strong organizational skills with a proven ability to prioritize and handle frequent changes in workload and able to manage competing priorities. Knowledge of insurance authorization process required. Excellent customer service and communication skills with the ability to discuss delicate matters with patients and referring providers required. Demonstrated knowledge and skills necessary to provide care to patients through the life span with consideration of aging processes, human development stages and cultural patterns in each step of the care process.ppWORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:pWork is performed in a typical medical office setting requiring extensive sitting, standing and walking. Reads referrals for new patient appointments for the majority of a day. Ability to work under fast paced sometimes stressful conditions to process new patient referrals meeting productivity and accuracy metrics. Organized and able to manage competing priorities ability to use good judgment by showing resourcefulness in problem solving.

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EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

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